Healthcare Provider Details

I. General information

NPI: 1376901694
Provider Name (Legal Business Name): CALCASIEU URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 SAM HOUSTON JONES PKWY
LAKE CHARLES LA
70611-5603
US

IV. Provider business mailing address

242 SAM HOUSTON JONES PKWY
LAKE CHARLES LA
70611-5603
US

V. Phone/Fax

Practice location:
  • Phone: 337-905-4000
  • Fax: 337-905-4003
Mailing address:
  • Phone: 337-905-4000
  • Fax: 337-905-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SYDNI CLEMMONS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 901-351-1791