Provider Demographics
NPI:1811060866
Name:LAKE CHARLES MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:LAKE CHARLES MEDICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:337-494-3202
Mailing Address - Street 1:2800 1ST AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8884
Mailing Address - Country:US
Mailing Address - Phone:337-439-1737
Mailing Address - Fax:337-439-4990
Practice Address - Street 1:2800 1ST AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8884
Practice Address - Country:US
Practice Address - Phone:337-439-1737
Practice Address - Fax:337-439-4990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-16
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012245207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LANG4865OtherBCBS
LA06-00004568OtherOCCUPATIONAL LICENSE
LACH1901OtherRAILROAD MEDICARE
LA1944408Medicaid
LA1944408Medicaid