Organization
LAKE CHARLES MEDICAL SERVICES, INC
Active
Parent organization
SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION
Other names
Rehabilitation Institute of Southwest LA
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION
Authorized official
MR. DAVID B USHER FACHE (V. P. OF OPERATIONS)
(337) 494-3202
Entity
Organization
Contact information
Practice address
1701 OAK PARK BLVD FL 2, LAKE CHARLES, LA 70601-8911
(337) 494-6868
(337) 494-6869
Mailing address
1717 OAK PARK BLVD FL 3, LAKE CHARLES, LA 70601-8990
(337) 494-6868
(337) 494-6869
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06-00010375
OCCUPATIONAL LICENSE
LA
01
—
DN5736
RR MEDICARE
LA
01
—
NH6455
BCBS
LA
Enumeration date
10/03/2006
Last updated
11/03/2008
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