Healthcare Provider Details

I. General information

NPI: 1598701583
Provider Name (Legal Business Name): LOUISIANA URGENT CARE OF OPELOUSAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 I-49 N. SERVICE RD #11
OPELOUSAS LA
70570-0722
US

IV. Provider business mailing address

5620 I-49 N. SERVICE RD #11
OPELOUSAS LA
70570-0722
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-6331
  • Fax: 337-942-9998
Mailing address:
  • Phone: 337-948-6331
  • Fax: 337-942-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD024344
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PATRICK D. MOORE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 337-948-6331