Organization
COLONNADE ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SABRA BROWN MOORE (ADMINISTRATOR)
(337) 439-6226
Entity
Organization
Contact information
Practice address
555 DR MICHAEL DEBAKEY DR STE 102, LAKE CHARLES, LA 70601
(337) 439-6226
(337) 436-8862
Mailing address
555 DR MICHAEL DEBAKEY DR STE 102, LAKE CHARLES, LA 70601-5700
(337) 439-6226
(337) 436-8862
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
099
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366536
—
LA
Enumeration date
11/10/2005
Last updated
06/28/2018
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