Provider Demographics
NPI:1023047776
Name:THE PSYCHIATRIC MEDICINE INSTITUTE OF LA LLC
Entity type:Organization
Organization Name:THE PSYCHIATRIC MEDICINE INSTITUTE OF LA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HOUMA DIXON
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:337-264-1991
Mailing Address - Street 1:850 KALISTE SALOOM RD
Mailing Address - Street 2:STE 115
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4230
Mailing Address - Country:US
Mailing Address - Phone:337-264-1991
Mailing Address - Fax:337-264-1993
Practice Address - Street 1:850 KALISTE SALOOM RD
Practice Address - Street 2:STE 115
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4230
Practice Address - Country:US
Practice Address - Phone:337-264-1991
Practice Address - Fax:337-264-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU56Medicare PIN