Provider Demographics
NPI:1225404072
Name:CALCASIEU URGENT CARE LLC
Entity Type:Organization
Organization Name:CALCASIEU URGENT CARE LLC
Other - Org Name:CALCASIEU URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNI
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-351-1791
Mailing Address - Street 1:1429 BEGLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5603
Mailing Address - Country:US
Mailing Address - Phone:337-528-8000
Mailing Address - Fax:337-528-4933
Practice Address - Street 1:1429 BEGLIS PKWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5603
Practice Address - Country:US
Practice Address - Phone:337-528-8000
Practice Address - Fax:337-528-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA261627Medicare PIN