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General NPI Number Information
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NPI Number | 1437400967
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Entity Type | Organization
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Legal Business Name | LOURDES AFTER HOURS LLC - BREAUX BRIDGE
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 1821 REES ST
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517
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Country | US
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Telephone | 337-442-6959
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Fax | 337-442-6961
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Provider Business Mailing Address
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Address Line | PO BOX 679636
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City | DALLAS
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State | TX
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Zip | 75267-9636
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVE SELLARS
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Credential | CEO
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Telephone | 225-214-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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