# IMPERIAL CALCASIEU MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932448354
- **Authorized official:** KRIS HICKINGBOTTOM (CEO)
- **Authorized official phone:** (337) 433-8400

## Contact information

- **Practice address:** 921 1ST AVE, SULPHUR, LA 70663-3424
- **Practice address phone:** (337) 527-6385
- **Practice address fax:** (337) 527-3527
- **Mailing address:** 501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
- **Mailing address phone:** (337) 312-8284
- **Mailing address fax:** (337) 312-6708

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/05/2013
- **Last updated:** 02/05/2013