| Molo Middle Sbhc | |
|
2300 Medora St Lake Charles LA 70601-1204 | |
| (337) 437-3977 | |
| (337) 437-8203 |
| Full Name | Molo Middle Sbhc |
|---|---|
| Speciality | Clinic/center - Student Health |
| Location | 2300 Medora St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Paul Trevino (CEO) |
| Authorized Official Contact | 4098998191 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Molo Middle Sbhc 524 Dr Michael Debakey Dr Lake Charles LA 70601-5725 Ph: (337) 437-3977 | Molo Middle Sbhc 2300 Medora St Lake Charles LA 70601-1204 Ph: (337) 437-3977 |
| NPI Number | 1205040995 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 07/05/2022 |
| Certification Date | 07/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205040995 | NPI | - | NPPES |
| 1447161 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | () | Primary |
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