Impact Physician Group, Louisiana LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

IMPACT PHYSICIAN GROUP, LOUISIANA LLC

Practice address

2720 Rue de Jardin Ste 100
Lake Charles, LA 70605-4050

Phone

(260) 407-8009

Fax

(260) 407-8009

NPI assigned

Jun 25, 2020

Last updated

Jun 25, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul Miller

Title

Credentialing Coordinator

Phone

(260) 407-8009

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1437775459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 EASTBROOK BND STE 218",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691546",
            "telephone_number": "260-407-8009",
            "fax_number": "260-407-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 RUE DE JARDIN STE 100",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054050",
            "telephone_number": "260-407-8009",
            "fax_number": "260-407-8009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICIAN GROUP, LOUISIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-25",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "260-407-8009"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Iles Medical Testing,LLC
• Impact Health & Wellness Lab, LLC
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• Imperial Calcasieu Human Services Authority (LCBHC Childrens Outreach Services)
• Imperial Calcasieu Human Services Authority (ImCal Primary Care)
• Imperial Calcasieu Human Services Authority (ImCal BH Lake Charles)
• Imperial Calcasieu Surgical Center LLC (Christus Imperial Calcasieu Surgical Center)

• Internal Medicine Physician in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.