Provider Demographics
NPI:1972075372
Name:BAYOU URGENT CARE
Entity Type:Organization
Organization Name:BAYOU URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:LOVERDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-923-9291
Mailing Address - Street 1:1947 HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2315
Mailing Address - Country:US
Mailing Address - Phone:936-367-3100
Mailing Address - Fax:800-700-0295
Practice Address - Street 1:1947 HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2315
Practice Address - Country:US
Practice Address - Phone:936-367-3100
Practice Address - Fax:800-700-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-23
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201965504Medicaid