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Organization
COASTAL PAIN CARE LAKE CHARLES, LLC
Active
Organization
COASTAL PAIN CARE LAKE CHARLES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KRISTI WIDCAMP (MANAGER)
(337) 477-9019
Entity
Organization
Contact information
Practice address
215 W PRIEN LAKE RD, LAKE CHARLES, LA 70601-8450
(337) 477-9019
(337) 478-1290
Mailing address
PO BOX 4840, LAKE CHARLES, LA 70606-4840
(337) 477-9019
(337) 478-1290
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
016824
LA
Other
Enumeration date
05/28/2006
Last updated
04/25/2013
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