| Calcasieu Parish Police Jury | |
|
1106 Ryan St Lake Charles LA 70601-5252 | |
| (337) 497-9355 | |
| Not Available |
| Full Name | Calcasieu Parish Police Jury |
|---|---|
| Speciality | Internal Medicine |
| Location | 1106 Ryan St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Jerry Milner (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 3377213650 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Calcasieu Parish Police Jury Po Box 3287 Lake Charles LA 70602-3287 Ph: (337) 721-3650 | Calcasieu Parish Police Jury 1106 Ryan St Lake Charles LA 70601-5252 Ph: (337) 497-9355 |
| NPI Number | 1518202902 |
|---|---|
| Provider Enumeration Date | 12/11/2012 |
| Last Update Date | 12/11/2012 |
| Medicare PECOS PAC ID | 6507003415 |
|---|---|
| Medicare Enrollment ID | O20130514000300 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518202902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD019378 (Louisiana) | Primary |
| Provider Name | Charles Grady Mclemore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497736995 PECOS PAC ID: 5496709024 Enrollment ID: I20050308000166 |
| Provider Name | Van Alan Snider |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407817190 PECOS PAC ID: 5395762744 Enrollment ID: I20051027000151 |
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