Organization
COMMUNITY MEDICAL GROUP-ST CHARLES INC
Active
Other names
Community Medical Group-St Charles Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN W MCDANIEL (CEO)
(504) 522-2014
Entity
Organization
Contact information
Practice address
1057 PAUL MAILLARD RD, SUITE2250, LULING, LA 70070-4349
(985) 785-2218
(985) 785-7753
Mailing address
503 MCMILLAN RD, WEST MONROE, LA 71291-5327
(318) 329-4700
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RI0200X
Infectious Disease Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2351036
—
LA
Enumeration date
09/09/2013
Last updated
02/17/2014
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