Organization
LAKE CHARLES MEDICAL SERVICES UROLOGY LLC
Active
Parent organization
LAKE CHARLES MEDICAL SERVICES, INC
Other names
Urology Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE CHARLES MEDICAL SERVICES, INC
Authorized official
DAWN JOHNSON-HATCHER (CFO)
(337) 494-2094
Entity
Organization
Contact information
Practice address
2770 3RD AVE STE 240, LAKE CHARLES, LA 70601-8994
(337) 494-4656
(337) 494-4657
Mailing address
PO BOX 122525 DEPT 2525, DALLAS, TX 75312-2525
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0700010826
OCCUPATIONAL LICENSE
LA
05
—
1030562
—
LA
01
—
NH6217
BCBS
LA
Enumeration date
03/06/2007
Last updated
12/04/2023
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