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Lake Charles Memorial Heart and Vascular Center

Organization Active NPI Cardiovascular Disease Physician · Lake Charles, LA

NPI 1407808405 · NPPES record last updated Mar 25, 2025

Key facts

NPI
1407808405
Entity type
Organization (NPI type 2)
Primary specialty
Cardiovascular Disease Physician 207RC0000X
Legal business name
LAKE CHARLES MEMORIAL HEART AND VASCULAR CENTER
Practice address
1717 Oak Park Blvd FL 2
Lake Charles, LA 70601-8990
Phone
(337) 494-3278
Fax
(337) 494-3240
NPI assigned
May 17, 2006
Organization subpart
Yes
Parent organization (as reported)
SOUTHWEST LOUISIANA HEALTH CARE SYSTEM, INC

Authorized official

Name
Dawn Johnson-Hatcher
Title
Cfo
Phone
(337) 494-2094

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0875355Heart and Vascular Center
1717 Oak Park Boulevard, Second Floor, Lake Charles, LA 70601		Certificate of waiverDec 22, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040901001355 LA Part B Supplier - Clinic/Group Practice 4082689914 Receives reassigned benefits from 16 practitioners
Practice locations: Sulphur, LA; Lake Charles, LA; Jennings, LA; Deridder, LA

National Provider Directory

Locations

501 S Pine St
Deridder, LA 70634
Phone (337) 462-3937

109 W 4th St
Deridder, LA 70634
Phone (337) 221-3004

913 E Kent Dr
Sulphur, LA 70663
Phone (337) 494-3278

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RC0000X LA Yes
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208G00000X LA

Addresses

Primary practice location

1717 Oak Park Blvd FL 2
Lake Charles, LA 70601-8990

Mailing address

PO Box 122152, Dept 2152 Dept 2152
Dallas, TX 75312-2152
Phone (337) 494-2921

Other practice location 1

1322 Elton Rd Ste E
Jennings, LA 70546-4100
Phone (337) 494-3278

Other practice location 2

913 E Kent Dr
Sulphur, LA 70663-5007
Phone (337) 494-3278

Other practice location 3

122 W 4th St
Dequincy, LA 70633-3508
Phone (337) 494-3278

Other practice location 4

109 W 4th St
Deridder, LA 70634-4849
Phone (337) 494-3278

Other identifiers

IdentifierTypeStateIssuer
CE9693OtherLARAILROAD MEDICARE
1948098MedicaidLA

Other names

  • HEART & VASCULAR CENTER Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 25, 2025.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1407808405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122152, DEPT 2152 DEPT 2152",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122152",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 OAK PARK BLVD FL 2",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018990",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1322 Elton Rd Ste E",
            "address_purpose": "LOCATION",
            "city": "Jennings",
            "state": "LA",
            "postal_code": "705464100",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "913 E Kent Dr",
            "address_purpose": "LOCATION",
            "city": "Sulphur",
            "state": "LA",
            "postal_code": "706635007",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "122 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Dequincy",
            "state": "LA",
            "postal_code": "706333508",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Deridder",
            "state": "LA",
            "postal_code": "706344849",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE CHARLES MEMORIAL HEART AND VASCULAR CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWEST LOUISIANA HEALTH CARE SYSTEM, INC",
        "enumeration_date": "2006-05-17",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-HATCHER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-494-2094"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "LA",
            "license": null,
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "LA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CE9693",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1948098",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEART & VASCULAR CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

All providers in Lake Charles, LA · Cardiovascular Disease Physician in Louisiana

Sources for this page

Verify at the official NPI Registry.