Provider Demographics
NPI:1972657674
Name:COURSEY URGENT CARE OF LOUISIANA
Entity Type:Organization
Organization Name:COURSEY URGENT CARE OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:225-755-1400
Mailing Address - Street 1:13702 COURSEY BLVD
Mailing Address - Street 2:BLDG 10 STE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1370
Mailing Address - Country:US
Mailing Address - Phone:225-755-1400
Mailing Address - Fax:225-755-1555
Practice Address - Street 1:13702 COURSEY BLVD
Practice Address - Street 2:BLDG 10 STE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1370
Practice Address - Country:US
Practice Address - Phone:225-755-1400
Practice Address - Fax:225-755-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023278261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care