Organization Active NPI

VCP 2 Louisiana Professional Corporation

  • Surgery Physician
  • Lake Charles, LA
National Provider Identifier
1679396907
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
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

Updated by the provider on Feb 4, 2025

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)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250130004134 LA Part B Supplier - Clinic/Group Practice 8123554094 Receives reassigned benefits from 2 practitioners
Practice locations: Lake Charles, LA

National Provider Directory

National Provider Directory

Locations

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.

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.

Verify at the official NPI Registry.