Basic Information
| Provider Information | |||||||||
| NPI: | 1376901694 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALCASIEU URGENT CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CALCASIEU URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 242 SAM HOUSTON JONES PKWY | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706115603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379054000 | ||||||||
| FaxNumber: | 3379054003 | ||||||||
| Practice Location | |||||||||
| Address1: | 242 SAM HOUSTON JONES PKWY | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706115603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379054000 | ||||||||
| FaxNumber: | 3379054003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2016 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | CLEMMONS | ||||||||
| AuthorizedOfficialFirstName: | SYDNI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9013511791 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.