Provider Demographics
NPI:1942552310
Name:CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT
Other - Org Name:UROLOGY CLINIC OF WEST CALCASIEU CAMERON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-527-4241
Mailing Address - Street 1:914 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5107
Mailing Address - Country:US
Mailing Address - Phone:337-527-6363
Mailing Address - Fax:337-528-2168
Practice Address - Street 1:914 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5107
Practice Address - Country:US
Practice Address - Phone:337-527-6363
Practice Address - Fax:337-528-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07139R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA190013Medicare Oscar/Certification