MEDICARE: CALCASIEU URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1467715490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALCASIEU URGENT CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 306416
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 COUNTRY CLUB RD
Second Line	:	SUITE 400
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5912
Country	:	US
Telephone Number	:	931-253-1110
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR CREDENTIALING & ENROLLMENT
Name	:	MELISSA HARLAN
Credential	:
Telephone Number	:	615-948-9639

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	08/15/2024

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