Healthcare Provider Details

I. General information

NPI: 1750638391
Provider Name (Legal Business Name): MINUTE MED CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 AMBASSADOR CAFFERY PKWY STE 100
LAFAYETTE LA
70503-5132
US

IV. Provider business mailing address

3619 AMBASSADOR CAFFERY PKWY BLDG E
LAFAYETTE LA
70503-5132
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-4410
  • Fax: 337-534-4426
Mailing address:
  • Phone: 337-534-4410
  • Fax: 337-534-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI ANN CORMIER-MIRE
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-534-4410