Organization
COASTAL PAIN CARE LAKE CHARLES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KRISTI WIDCAMP (MANAGER)
(337) 477-9019
Entity
Organization
Contact information
Practice address
215 W PRIEN LAKE RD, LAKE CHARLES, LA 70601-8450
(337) 477-9019
(337) 478-1290
Mailing address
PO BOX 4840, LAKE CHARLES, LA 70606-4840
(337) 477-9019
(337) 478-1290
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
016824
LA
Other
Enumeration date
05/28/2006
Last updated
04/25/2013
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