Healthcare Provider Details

I. General information

NPI: 1720505134
Provider Name (Legal Business Name): URGENT CARE OF LAFAYETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 S COLLEGE RD STE 203
LAFAYETTE LA
70503-3062
US

IV. Provider business mailing address

202 VILLAGE CIR STE 1
SLIDELL LA
70458-5418
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-5781
  • Fax: 337-234-5341
Mailing address:
  • Phone: 985-726-9605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE A GALLOWAY
Title or Position: PRESIDENT
Credential:
Phone: 985-726-9605