Healthcare Provider Details

I. General information

NPI: 1881829794
Provider Name (Legal Business Name): PREMIER URGENT CARE AND BARIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 FORSYTHE BYP # 104
MONROE LA
71201-2168
US

IV. Provider business mailing address

5000 FORSYTHE BYP # 104
MONROE LA
71201-2168
US

V. Phone/Fax

Practice location:
  • Phone: 318-348-4699
  • Fax:
Mailing address:
  • Phone: 318-348-4699
  • 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: MICHAEL STAMPER
Title or Position: MEMBER
Credential:
Phone: 318-348-4699