Organization
IMPERIAL CALCASIEU MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRIS HICKINGBOTTOM (CEO)
(337) 433-8400
Entity
Organization
Contact information
Practice address
921 1ST AVE, SULPHUR, LA 70663-3424
(337) 527-6385
(337) 527-3527
Mailing address
501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
(337) 312-8284
(337) 312-6708
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/05/2013
Last updated
02/05/2013
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