EXECUTIVE MEDICAL CLINIC OF LAKE CHARLES NPI 1982126520

NPI Information

EXECUTIVE MEDICAL CLINIC OF LAKE CHARLES is a family medicine in Lake Charles, LA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. EXECUTIVE MEDICAL CLINIC OF LAKE CHARLES NPI is 1982126520. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

765 EAST BAYOU PINES DRIVE
LAKE CHARLES, LA
ZIP 70601-690
Phone: (337) 210-1260

The provider's authorized official is Melissa Lebrun .
The authorized official title is President and has the following contact phone number (225) 939-0050.

The CLIA number assigned to this NPI record is 19D2263808 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/14/2017 and was last updated on 9/19/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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