# COMMUNITY MEDICAL GROUP-ST CHARLES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Community Medical Group-St Charles Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407281546
- **Authorized official:** MR. JOHN W MCDANIEL (CEO)
- **Authorized official phone:** (504) 522-2014

## Contact information

- **Practice address:** 1057 PAUL MAILLARD RD, SUITE2250, LULING, LA 70070-4349
- **Practice address phone:** (985) 785-2218
- **Practice address fax:** (985) 785-7753
- **Mailing address:** 503 MCMILLAN RD, WEST MONROE, LA 71291-5327
- **Mailing address phone:** (318) 329-4700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RI0200X | Infectious Disease Physician | — | NULL | — |
| 207RI0200X | Infectious Disease Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |

## Other

- **Enumeration date:** 09/09/2013
- **Last updated:** 02/17/2014