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EXECUTIVE MEDICAL CLINIC OF LAKE CHARLES
NPI 1982126520
Family Medicine in Lake Charles, LA

Active since July 14, 2017CLIA 19D2133514 · Waiver
765 EAST BAYOU PINES DRIVE, LAKE CHARLES, LA 70601(337) 210-1260 Get Directions Write a Review

NPPES record last updated: September 19, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 19, 2022, Jul 21, 2022, Jul 14, 2017 (3 updates tracked since 2017).

About Executive Medical Clinic Of Lake Charles NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EXECUTIVE MEDICAL CLINIC OF LAKE CHARLES (NPI 1982126520) is a healthcare organization registered as a family medicine in Lake Charles, Louisiana and active in the NPI registry since July 2017. The organization holds a CLIA Waiver certificate valid through July 13, 2027 and lists Melissa Lebrun, President, as its authorized official.

NPPES Registry Identity

NPI1982126520
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameEXECUTIVE MEDICAL CLINIC OF LAKE CHARLES
Location Address765 EAST BAYOU PINES DRIVELake Charles, LA 70601-5690
Mailing Address765 East Bayou Pines DriveLake Charles, LA 70601-5690 · (337) 210-1260
Phone(337) 210-1260
Organization SubpartNo
Authorized OfficialMelissa LebrunPresident · (225) 939-0050
Enumeration DateJuly 14, 2017
Last NPPES UpdateSeptember 19, 20223 updates tracked since enumeration
NPPES CertifiedSeptember 14, 2022
✔ NPI 1982126520 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in LA · AP06496
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
765 EAST BAYOU PINES DRIVE, Lake Charles, LA 70601
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D2133514

Executive Medical Clinic Of Lake Charles · Lake Charles, LA
Active · expires Jul 13, 2027
CLIA Number19D2133514
Laboratory TypePhysician Office
Certificate Effective DateJuly 14, 2025
Certificate Expiration DateJuly 13, 2027
Laboratory DirectorJessica Sonnier
Laboratory Phone(332) 210-1260
Laboratory LocationExecutive Medical Clinic Of Lake Charles765 Bayou Pines East Dr, Lake Charles, LA 70601
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 19D2263808

Executive Medical Clinic Of Lake Charles · Lake Charles, LA
Expired · Jul 5, 2026
CLIA Number19D2263808
Laboratory TypePhysician Office
Certificate Effective DateJuly 6, 2024
Certificate Expiration DateJuly 5, 2026
Laboratory DirectorJessica Sonnier
Laboratory Phone(337) 210-1260
Laboratory LocationExecutive Medical Clinic Of Lake Charles765 Bayou Pines East, Lake Charles, LA 70601
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Executive Medical Clinic Of Lake Charles's NPI number?

The NPI number for Executive Medical Clinic Of Lake Charles is 1982126520. It was assigned to this organization in the NPPES registry on July 14, 2017.

Where is Executive Medical Clinic Of Lake Charles located?

Executive Medical Clinic Of Lake Charles is located at 765 East Bayou Pines Drive, Lake Charles, LA 70601. The listed phone number is (337) 210-1260.

What is Executive Medical Clinic Of Lake Charles's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Executive Medical Clinic Of Lake Charles hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D2133514) is associated with this NPI, valid through July 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Executive Medical Clinic Of Lake Charles was last updated on September 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.