Healthcare Provider Details

I. General information

NPI: 1447934187
Provider Name (Legal Business Name): GULF COAST URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E PRIEN LAKE RD
LAKE CHARLES LA
70601-8507
US

IV. Provider business mailing address

PO BOX 4755
LAKE CHARLES LA
70606-4755
US

V. Phone/Fax

Practice location:
  • Phone: 337-436-7216
  • Fax: 337-436-7217
Mailing address:
  • Phone: 337-436-7216
  • Fax: 337-436-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA CLAYTON GRAY
Title or Position: OWNER
Credential: NP
Phone: 337-842-1397