Provider Demographics
NPI:1902249808
Name:COASTAL URGENT CARE OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:COASTAL URGENT CARE OF LOUISIANA, LLC
Other - Org Name:COASTAL URGENT CARE OF HOUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENNAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:UTER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:225-706-3033
Mailing Address - Street 1:4520 JAMESTOWN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3214
Mailing Address - Country:US
Mailing Address - Phone:225-706-3033
Mailing Address - Fax:225-218-4888
Practice Address - Street 1:1411 ST. CHARLES ST.
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3964
Practice Address - Country:US
Practice Address - Phone:985-709-0136
Practice Address - Fax:985-709-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care