Healthcare Provider Details

I. General information

NPI: 1891517512
Provider Name (Legal Business Name): LOUISIANA STAT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11055 SHOE CREEK DR
BATON ROUGE LA
70818-4022
US

IV. Provider business mailing address

11055 SHOE CREEK DR
BATON ROUGE LA
70818-4022
US

V. Phone/Fax

Practice location:
  • Phone: 225-261-4493
  • Fax:
Mailing address:
  • Phone: 225-261-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA WOODARD
Title or Position: OWNER
Credential:
Phone: 225-261-4493