Provider Demographics
NPI:1598159279
Name:HULIN URGENT CARE SERVICES, LLC
Entity Type:Organization
Organization Name:HULIN URGENT CARE SERVICES, LLC
Other - Org Name:SOUTHSTAR URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HULIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:337-364-1166
Mailing Address - Street 1:1110 E SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3932
Mailing Address - Country:US
Mailing Address - Phone:337-364-1166
Mailing Address - Fax:337-364-7090
Practice Address - Street 1:6770 JOHNSTON ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-6202
Practice Address - Country:US
Practice Address - Phone:337-326-5702
Practice Address - Fax:337-326-5703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HULIN URGENT CARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-20
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DY15Medicare PIN
LA6805510001Medicare NSC