MEMORIAL MEDICAL GROUP, LLC (NPI# 1750846663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750846663 |
| Entity Type | Organization |
| Organization Name | MEMORIAL MEDICAL GROUP, LLC |
| Practice Address |
1701 Oak Park Blvd Lake Charles LA 70601-8911 |
| Practice Telephone | 3374943000 |
| Mailing Telephone | 3374943000 |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | SARAH THERESA LEBLANC (BUSINESS OFFICE ANALYST /PROGRAMMER) |
| Authorized Official Telephone | 3374942577 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235474057 | Memorial Medical Group, LLC | Anesthesiology | 4550 Memorial Dr, Ste. 340, Belleville, IL 62226-5372 | 2012-12-05 |
| Street Address |
1701 OAK PARK BLVD |
| City | LAKE CHARLES |
| State | LA |
| Zip Code | 70601-8911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972549855 | Southwest Louisiana Hospital Association | General Acute Care Hospital | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2006-06-21 |
| 1699386672 | Alexis Batiste | Nurse Anesthetist, Certified Registered | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2020-08-12 |
| 1912530510 | Kathryn Claire Anderson | Nurse Practitioner | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2020-02-21 |
| 1902450851 | Jed Michael Guillory | Nurse Practitioner | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2019-07-29 |
| 1598328189 | Joshua Clayton Gray | Nurse Practitioner | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2019-04-18 |
| 1306331004 | Austin Goings | Nurse Practitioner | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2018-06-25 |
| 1649767724 | Melanie Bousegard White | Nurse Practitioner | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2018-04-16 |
| 1518461706 | Brandon Shea Blanchard | Nurse Practitioner | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2018-03-21 |
| 1790293645 | Lauren Courville | Nurse Practitioner | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2018-01-12 |
| 1609382589 | Caitlin L Lafleur | Specialist/Technologist | 1701 Oak Park Blvd, Lake Charles, LA 70601-8911 | 2017-12-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144833872 | Fresenius Medical Care Sulphur, LLC | Clinic/Center | 330 Chavanne Street, Lake Charles, LA 70601 | 2020-08-24 |
| 1174158844 | Andrea Cormier | Peer Specialist | 751 E Bayou Pines Drive, Suite C, Lake Charles, LA 70601 | 2020-03-03 |
| 1588297303 | Vivian Claire Miller Monceaux | Chiropractor | 780 Bayou Pines East Drive, Lake Charles, LA 70601 | 2020-02-20 |
| 1568001014 | Swla Center for Health Services | Clinic/Center | 3820 Senator J. Bennett Johnston Ave, Charleston Bldg 8, Lake Charles, LA 70601 | 2020-01-02 |
| 1417512070 | Ryan Nathaniel Vaisler | Student in an Organized Health Care Education/Training Program | 1525 Oak Park Blvd., Lake Charles, LA 70601 | 2019-05-08 |
| 1336600675 | Hoh Palliative Care, LLC | Family Medicine | 750 East Bayou Pines, Suite A, Lake Charles, LA 70601 | 2019-03-28 |
| 1073079026 | Alawrass LLC | Pharmacy | 803 E Prien Lake Rd, Lake Charles, LA 70601 | 2019-02-14 |
| 1861962722 | Ellaweena Woods | Counselor | 1409 Kirkman St., Lake Charles, LA 70601 | 2018-12-04 |
| 1770051963 | Hanna Marie Rodriguez | Counselor | 751 Bayou Pines Drive, Suite C, Lake Charles, LA 70601 | 2018-11-06 |
| 1023585213 | Shandora Druilhet | Case Manager/Care Coordinator | 751 E Bayou Pines, Lake Charles, LA 70601 | 2018-10-26 |
| Find all providers in zip 70601 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982126520 | Executive Medical Clinic of Lake Charles | Family Medicine | 2002 W Walnut St Ste 1a, Lake Charles, LA 70601-5690 | 2017-07-14 |
| 1295184786 | Trina Health of Lake Charles, LLC | Family Medicine | 1714 Wolf Circle, Lake Charles, LA 70605-4050 | 2016-06-06 |
| 1740600683 | Jason Burklow | Family Medicine | 4150 Nelson Rd Ste 3, Lake Charles, LA 70605-4148 | 2014-04-18 |
| 1174871123 | Imperial Health LLP | Family Medicine | 1920 W Sale Rd Bldg F, Lake Charles, LA 70605-2400 | 2012-08-23 |
| 1790033744 | Imperial Health LLP | Family Medicine | 277 N Highway 171 Ste 8, Lake Charles, LA 70611-5374 | 2012-08-23 |
| 1194081414 | Clint Nickolas Lincoln | Family Medicine | 10071 Gulf Hwy, Lake Charles, LA 70607 | 2012-04-11 |
| 1972873610 | Terry Welke | Family Medicine | 707 E Prien Lake Rd Ste B, Lake Charles, LA 70601-8788 | 2012-01-11 |
| 1982839445 | Star Care Service Inc | Family Medicine | 313 Alamo St, Suite B, Lake Charles, LA 70601-8528 | 2009-05-27 |
| 1982862736 | Kamran Mohammad Chaudary | Family Medicine | 4918 E Westridge Park Dr, Lake Charles, LA 70605-6762 | 2008-05-29 |
| 1821255852 | Penny Lynn Goodwin | Family Medicine | 237 Sam Houston Jones Pkwy, Lake Charles, LA 70611-5603 | 2008-05-19 |
| Find all providers in LAKE CHARLES | ||||
| City | LAKE CHARLES |
| Zip Code | 70601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.