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General NPI Number Information
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NPI Number | 1902249808
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Entity Type | Organization
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Legal Business Name | COASTAL URGENT CARE OF LOUISIANA, LLC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 1411 ST. CHARLES ST.
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City | HOUMA
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State | LA
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Zip | 70360-3964
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Country | US
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Telephone | 985-709-0136
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Fax | 985-709-0527
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Provider Business Mailing Address
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Address Line | 4520 JAMESTOWN AVE STE 3
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City | BATON ROUGE
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State | LA
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Zip | 70808-3214
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Country | US
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Telephone | 225-706-3033
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Fax | 225-218-4888
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Authorized Official
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Title or Position | OWNER, MANAGING PARTNER
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Name | MR. BRENNAN D UTER
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Credential | MHA
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Telephone | 225-706-3033
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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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