Healthcare Provider Details

I. General information

NPI: 1538575105
Provider Name (Legal Business Name): MISS-LOU URGENT CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E AIRPORT AVE
BATON ROUGE LA
70806
US

IV. Provider business mailing address

505 E AIRPORT AVE
BATON ROUGE LA
70806
US

V. Phone/Fax

Practice location:
  • Phone: 225-201-0950
  • Fax:
Mailing address:
  • Phone: 225-201-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARCY ROGERS
Title or Position: ADMINISTRATOR
Credential: MA ED
Phone: 858-335-8254