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NPI Code Detail

MEDICARE: LAKE URGENT CARE ASCENSION LLC

MEDICARE: LAKE URGENT CARE ASCENSION 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
1261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1912243122
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE URGENT CARE ASCENSION LLC
Provider Business Mailing Address
First Line : PO BOX 679641
Second Line :
City : DALLAS
State : TX
Zip : 75267-9641
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14350 HIGHWAY 73
Second Line :
City : PRAIRIEVILLE
State : LA
Zip : 70769-3617
Country : US
Telephone Number : 225-313-3930
Fax Number : 225-313-3940
Authorized Official
Title or Position : VP FINANCE
Name : JAMY RICHARD
Credential :
Telephone Number : 225-526-0121
Provider Enumeration Date : 12/14/2012
Last Update Date : 05/12/2026

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Directions to “LAKE URGENT CARE ASCENSION LLC ” Practice Location

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