Healthcare Provider Details

I. General information

NPI: 1437400967
Provider Name (Legal Business Name): LOURDES AFTER HOURS LLC - BREAUX BRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 REES ST
BREAUX BRIDGE LA
70517
US

IV. Provider business mailing address

PO BOX 679636
DALLAS TX
75267-9636
US

V. Phone/Fax

Practice location:
  • Phone: 337-442-6959
  • Fax: 337-442-6961
Mailing address:
  • Phone:
  • 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: STEVE SELLARS
Title or Position: PRESIDENT
Credential: CEO
Phone: 225-214-9353