| Premier Internal Medicine | |
|
4211 Lake St Ste 80 Lake Charles LA 70605-5001 | |
| (337) 448-4599 | |
| Not Available |
| Full Name | Premier Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 4211 Lake St Ste 80, Lake Charles, Louisiana |
| Authorized Official Name and Position | Susan Bourgeois Ieyoub (OWNER) |
| Authorized Official Contact | 3375405132 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Internal Medicine 3801 Placid Ln Lake Charles LA 70605-6773 Ph: (337) 540-5132 | Premier Internal Medicine 4211 Lake St Ste 80 Lake Charles LA 70605-5001 Ph: (337) 448-4599 |
| NPI Number | 1447116686 |
|---|---|
| Provider Enumeration Date | 12/31/2025 |
| Last Update Date | 02/04/2026 |
| Certification Date | 02/04/2026 |
| Medicare PECOS PAC ID | 6002397452 |
|---|---|
| Medicare Enrollment ID | O20260224001382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447116686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Susan B Ieyoub |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255404521 PECOS PAC ID: 7214069707 Enrollment ID: I20100719000886 |
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