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NPI Code Detail

MEDICARE: COASTAL URGENT CARE OF LOUISIANA, LLC

MEDICARE: COASTAL URGENT CARE OF LOUISIANA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1902249808
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL URGENT CARE OF LOUISIANA, LLC
Provider Business Mailing Address
First Line : 4520 JAMESTOWN AVE STE 3
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-3214
Country : US
Telephone Number : 225-706-3033
Fax Number : 225-218-4888
Provider Business Practice Location Address
First Line : 1411 ST. CHARLES ST.
Second Line :
City : HOUMA
State : LA
Zip : 70360-3964
Country : US
Telephone Number : 985-709-0136
Fax Number : 985-709-0527
Authorized Official
Title or Position : OWNER, MANAGING PARTNER
Name : MR. BRENNAN D UTER
Credential : MHA
Telephone Number : 225-706-3033
Provider Enumeration Date : 04/10/2013
Last Update Date : 02/21/2023

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Directions to “COASTAL URGENT CARE OF LOUISIANA, LLC ” Practice Location

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