Healthcare Provider Details

I. General information

NPI: 1568601425
Provider Name (Legal Business Name): COASTAL URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 03/19/2024
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 S BURNSIDE AVE SUITE A100
GONZALES LA
70737-4249
US

IV. Provider business mailing address

600 JEFFERSON ST STE 600
LAFAYETTE LA
70501-6987
US

V. Phone/Fax

Practice location:
  • Phone: 225-644-5508
  • Fax: 225-751-6686
Mailing address:
  • Phone: 337-202-0720
  • 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: ERICA HAUSER
Title or Position: CFO
Credential:
Phone: 312-590-5372