Organization
COASTAL SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTI WIDCAMP (MANAGER)
(337) 477-9019
Entity
Organization
Contact information
Practice address
215 W PRIEN LAKE RD, SUITE B, LAKE CHARLES, LA 70601-8450
(337) 477-9019
(337) 478-1290
Mailing address
PO BOX 4838, LAKE CHARLES, LA 70606-4838
(337) 477-9019
(337) 478-1290
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
LA
Other
Enumeration date
07/29/2009
Last updated
04/22/2013
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