Provider Demographics
NPI:1912243122
Name:LAKE URGENT CARE ASCENSION LLC
Entity Type:Organization
Organization Name:LAKE URGENT CARE ASCENSION LLC
Other - Org Name:LAKE URGENT CARE - ASCENSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-214-9353
Mailing Address - Street 1:PO BOX 679641
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-9641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14350 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3617
Practice Address - Country:US
Practice Address - Phone:225-313-3930
Practice Address - Fax:225-313-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care