Provider Demographics
NPI:1447517909
Name:LAKE CHARLES CLINICAL TRIALS, LLC
Entity type:Organization
Organization Name:LAKE CHARLES CLINICAL TRIALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KASHINATH
Authorized Official - Middle Name:
Authorized Official - Last Name:YADALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-564-6405
Mailing Address - Street 1:3712 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2571
Mailing Address - Country:US
Mailing Address - Phone:337-564-6405
Mailing Address - Fax:337-656-2564
Practice Address - Street 1:ONE LAKESHORE DRIVE,
Practice Address - Street 2:SUITE 1695
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70629
Practice Address - Country:US
Practice Address - Phone:337-564-6405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 08664R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center