Provider Demographics
NPI:1598701583
Name:LOUISIANA URGENT CARE OF OPELOUSAS, LLC
Entity Type:Organization
Organization Name:LOUISIANA URGENT CARE OF OPELOUSAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-948-6331
Mailing Address - Street 1:5620 I-49 N. SERVICE RD
Mailing Address - Street 2:#11
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0722
Mailing Address - Country:US
Mailing Address - Phone:337-948-6331
Mailing Address - Fax:337-942-9998
Practice Address - Street 1:5620 I-49 N. SERVICE RD
Practice Address - Street 2:#11
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0722
Practice Address - Country:US
Practice Address - Phone:337-948-6331
Practice Address - Fax:337-942-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD024344207Q00000X
261QU0200X, 332900000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1027090Medicaid
LA5CV45Medicare UPIN