Healthcare Provider Details

I. General information

NPI: 1487024618
Provider Name (Legal Business Name): LAKE URGENT CARE ASCENSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10714 HIGHWAY 431
SAINT AMANT LA
70774-3904
US

IV. Provider business mailing address

PO BOX 679641
DALLAS TX
75267-9641
US

V. Phone/Fax

Practice location:
  • Phone: 225-644-0005
  • Fax: 225-214-9349
Mailing address:
  • Phone:
  • 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: STEVE SELLARS
Title or Position: PRESIDENT
Credential:
Phone: 225-214-9353