Organization Name:  UROLOGY SPECIALTY AND SURGERY CENTER OF SOUTHWEST LOUISIANA


Practice Location:
234 DR MICHAEL DEBAKEY DR  LAKE CHARLES, LA 70601 US
Tel: 337-439-8857  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical	LA	42

Other Provider Identifiers:

Issuer	Number	State	Type
RAILROAD MEDICARE	490001185	LA	01
BLUE CROSS BLUE SHIELD	2097C	LA	01
	1390429	LA	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin