Coastal Surgery Center, LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

COASTAL SURGERY CENTER, LLC

Practice address

215 W Prien Lake Rd
Suite B
Lake Charles, LA 70601-8450

Phone

(337) 477-9019

Fax

(337) 478-1290

NPI assigned

Jul 29, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Kristi Widcamp

Title

Manager

Phone

(337) 477-9019

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366588800000",
    "number": "1962633636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4838",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706064838",
            "telephone_number": "337-477-9019",
            "fax_number": "337-478-1290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W PRIEN LAKE RD",
            "address_2": "SUITE B",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018450",
            "telephone_number": "337-477-9019",
            "fax_number": "337-478-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-29",
        "last_updated": "2013-04-22",
        "status": "A",
        "authorized_official_last_name": "WIDCAMP",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "337-477-9019",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah E Clevenger, M.D.
• Clinic808 LLC
• Kashia Clopper
• Emily Clyde, MS, RDN, LDN
• Coastal Pain Care Lake Charles, LLC
• Amber Coates
• Kelsey Cobb, FNP
• Jacob Gus Cochran
• Robert Charles Cochran, DDS
• Amber N. Cockburn, MD

• All providers in Lake Charles, LA
• Pain Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; 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.