| Impact Physician Group, Louisiana Llc | |
|
2720 Rue De Jardin Ste 100 Lake Charles LA 70605-4050 | |
| (260) 407-8009 | |
| (260) 407-8009 |
| Full Name | Impact Physician Group, Louisiana Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2720 Rue De Jardin Ste 100, Lake Charles, Louisiana |
| Authorized Official Name and Position | Paul Miller (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2604078009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Physician Group, Louisiana Llc 21 Eastbrook Bnd Ste 218 Peachtree City GA 30269-1546 Ph: (260) 407-8009 | Impact Physician Group, Louisiana Llc 2720 Rue De Jardin Ste 100 Lake Charles LA 70605-4050 Ph: (260) 407-8009 |
| NPI Number | 1437775459 |
|---|---|
| Provider Enumeration Date | 06/25/2020 |
| Last Update Date | 06/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437775459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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