| Clark A Gunderson Md Amc | |
|
2615 Enterprise Blvd Lake Charles LA 70601-7686 | |
| (337) 439-0385 | |
| (337) 433-5448 |
| Full Name | Clark A Gunderson Md Amc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2615 Enterprise Blvd, Lake Charles, Louisiana |
| Authorized Official Name and Position | Clark A Gunderson (PRESIDENT) |
| Authorized Official Contact | 3374390385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark A Gunderson Md Amc 2615 Enterprise Blvd Lake Charles LA 70601-7686 Ph: (337) 439-0385 | Clark A Gunderson Md Amc 2615 Enterprise Blvd Lake Charles LA 70601-7686 Ph: (337) 439-0385 |
| NPI Number | 1861766321 |
|---|---|
| Provider Enumeration Date | 03/01/2012 |
| Last Update Date | 03/01/2012 |
| Medicare PECOS PAC ID | 2466611520 |
|---|---|
| Medicare Enrollment ID | O20120308000453 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861766321 | NPI | - | NPPES |
| 114305 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0124589 (Louisiana) | Primary |
| Provider Name | Clark A Gunderson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1083831887 PECOS PAC ID: 3173782240 Enrollment ID: I20120308000622 |
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