| Reynard C Odenheimer Md A Professional Medical Corporation | |
|
816 W Bayou Pines Dr Lake Charles LA 70601-7077 | |
| (337) 439-5588 | |
| (337) 439-0808 |
| Full Name | Reynard C Odenheimer Md A Professional Medical Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 816 W Bayou Pines Dr, Lake Charles, Louisiana |
| Authorized Official Name and Position | Pat Gail Kersch (OFFICE MANAGER) |
| Authorized Official Contact | 3374395588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reynard C Odenheimer Md A Professional Medical Corporation 816 W Bayou Pines Dr Lake Charles LA 70601-7077 Ph: (337) 439-5588 | Reynard C Odenheimer Md A Professional Medical Corporation 816 W Bayou Pines Dr Lake Charles LA 70601-7077 Ph: (337) 439-5588 |
| NPI Number | 1215326756 |
|---|---|
| Provider Enumeration Date | 01/22/2015 |
| Last Update Date | 01/22/2015 |
| Medicare PECOS PAC ID | 1557685443 |
|---|---|
| Medicare Enrollment ID | O20150126000246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215326756 | NPI | - | NPPES |
| 1684821 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 020159 (Louisiana) | Primary |
| Provider Name | Reynard C Odenheimer |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1528158292 PECOS PAC ID: 1759483431 Enrollment ID: I20070227000281 |
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