| Moss Bluff Medical Clinic | |
|
217 Sam Houston Jones Pkwy Suite 101 Lake Charles LA 70611-5603 | |
| (337) 217-1000 | |
| Not Available |
| Full Name | Moss Bluff Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 217 Sam Houston Jones Pkwy, Lake Charles, Louisiana |
| Authorized Official Name and Position | Sandra D Bruno (OWNER) |
| Authorized Official Contact | 3372171000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moss Bluff Medical Clinic 217 Sam Houston Jones Pkwy Suite 101 Lake Charles LA 70611-5603 Ph: (337) 217-1000 | Moss Bluff Medical Clinic 217 Sam Houston Jones Pkwy Suite 101 Lake Charles LA 70611-5603 Ph: (337) 217-1000 |
| NPI Number | 1295868024 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1355537739 |
|---|---|
| Medicare Enrollment ID | O20101124000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295868024 | NPI | - | NPPES |
| 1677027 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 020956 (Louisiana) | Primary |
| Provider Name | Sandra D M Bruno |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972533602 PECOS PAC ID: 1052507431 Enrollment ID: I20101124000586 |
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