Healthcare Provider Details

I. General information

NPI: 1326072018
Provider Name (Legal Business Name): LOUISIANA URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/03/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 HWY 1 SOUTH
PORT ALLEN LA
70767
US

IV. Provider business mailing address

PO BOX 147
BRUSLY LA
70719
US

V. Phone/Fax

Practice location:
  • Phone: 225-749-2273
  • Fax:
Mailing address:
  • Phone: 225-749-2273
  • 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: DR. LEONE ELLIOTT
Title or Position: OWNER
Credential: MD
Phone: 225-749-2273