| Thornell Mitchell | |
|
2121 Lake St Lake Charles LA 70601-7103 | |
| (337) 433-1919 | |
| (337) 433-1928 |
| Full Name | Thornell Mitchell |
|---|---|
| Speciality | Clinic/center |
| Location | 2121 Lake St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Gloria D Kennison (OFFICE MANAGER) |
| Authorized Official Contact | 3374331919 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thornell Mitchell 2121 Lake St Lake Charles LA 70601-7103 Ph: (337) 433-1919 | Thornell Mitchell 2121 Lake St Lake Charles LA 70601-7103 Ph: (337) 433-1919 |
| NPI Number | 1770818759 |
|---|---|
| Provider Enumeration Date | 10/09/2009 |
| Last Update Date | 10/09/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770818759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1137 (Louisiana) | Primary |
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