| Breaux Internal Medicine And Pediatric Clinic | |
|
711 S Ryan St Suite 600 Lake Charles LA 70601-5785 | |
| (337) 491-7072 | |
| (337) 491-7076 |
| Full Name | Breaux Internal Medicine And Pediatric Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 711 S Ryan St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Adrienne Lynn Breaux (OWNER) |
| Authorized Official Contact | 3374917072 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breaux Internal Medicine And Pediatric Clinic 711 S Ryan St Suite 600 Lake Charles LA 70601-5785 Ph: (337) 491-7072 | Breaux Internal Medicine And Pediatric Clinic 711 S Ryan St Suite 600 Lake Charles LA 70601-5785 Ph: (337) 491-7072 |
| NPI Number | 1457531881 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 11/14/2007 |
| Medicare PECOS PAC ID | 0749361152 |
|---|---|
| Medicare Enrollment ID | O20080111000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457531881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0700011300 (Louisiana) | Primary |
| Provider Name | Adrienne L Breaux |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518008341 PECOS PAC ID: 0749377208 Enrollment ID: I20071030000596 |
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