Active NPI
VCP 2 Louisiana Professional Corporation
- Surgery Physician
- Lake Charles, LA
National Provider Identifier
1679396907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- VCP 2 LOUISIANA PROFESSIONAL CORPORATION
- Practice address
- 750 Bayou Pines East Dr
Lake Charles, LA 70601-7184 - Phone
- (866) 328-8346
- Fax
- (706) 854-2149
- NPI assigned
- Nov 5, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jewell Halliburton
- Title
- Regional Practice Administrator
- Phone
- (706) 888-1256
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
750 Bayou Pines East Dr
Lake Charles, LA 70601-7184
Mailing address
1109 Medical Center Dr BLDG 1a
Augusta, GA 30909-6633
Phone (866) 328-8346
Other names 1
- Vein Guys
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
750 Bayou Pines East Dr
Lake Charles, LA 70601
Phone (337) 210-4242
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Lake Charles, LA
- NPI 1760688311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730764800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1738627200000",
"number": "1679396907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1109 MEDICAL CENTER DR BLDG 1A",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309096633",
"telephone_number": "866-328-8346",
"fax_number": "706-854-2149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 BAYOU PINES EAST DR",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706017184",
"telephone_number": "866-328-8346",
"fax_number": "706-854-2149"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VCP 2 LOUISIANA PROFESSIONAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2024-11-05",
"last_updated": "2025-02-04",
"certification_date": "2025-02-04",
"status": "A",
"authorized_official_last_name": "HALLIBURTON",
"authorized_official_first_name": "JEWELL",
"authorized_official_title_or_position": "REGIONAL PRACTICE ADMINISTRATOR",
"authorized_official_telephone_number": "706-888-1256"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Vein Guys",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Vein Guys",
"code": "3",
"type": "Doing Business As"
}
]
}
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 Feb 4, 2025; 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.