NPIMap

Organization Active NPI

Lake Charles Intraoperative Neuromonitoring, LLC

  • Specialist
  • Lake Charles, LA
National Provider Identifier
1619640216
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
LAKE CHARLES INTRAOPERATIVE NEUROMONITORING, LLC
Practice address
701 W School St
Lake Charles, LA 70605-2760
Phone
(133) 788-4455
NPI assigned
Jul 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Authorized official

Name
Mr. Jeffrey B Holland, CNIM
Title
Owener
Phone
(337) 884-4550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

701 W School St
Lake Charles, LA 70605-2760

Mailing address

701 W School St
Lake Charles, LA 70605-2760
Phone (337) 884-4550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210930000137 LA Part B Supplier - Clinic/Group Practice 1658778865 Receives reassigned benefits from 3 practitioners
Practice locations: Lake Charles, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627516800000",
    "number": "1619640216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W SCHOOL ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706052760",
            "telephone_number": "337-884-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W SCHOOL ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706052760",
            "telephone_number": "133-788-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CHARLES INTRAOPERATIVE NEUROMONITORING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWENER",
        "authorized_official_telephone_number": "337-884-4550",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CNIM"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.