Healthcare Provider Details

I. General information

NPI: 1396978615
Provider Name (Legal Business Name): PREMIER URGENT CARE AND BARIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 WARREN DR STE B
WEST MONROE LA
71291-7158
US

IV. Provider business mailing address

903 WARREN DR STE B
WEST MONROE LA
71291-7158
US

V. Phone/Fax

Practice location:
  • Phone: 318-537-9320
  • Fax: 318-537-9323
Mailing address:
  • Phone: 318-537-9320
  • Fax: 318-537-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY MICHAEL STAMPER
Title or Position: PRESIDENT
Credential:
Phone: 318-348-4699