Provider Demographics
NPI:1982919262
Name:CONVENIENT CARE LLC
Entity Type:Organization
Organization Name:CONVENIENT CARE LLC
Other - Org Name:LAKE AFTER HOURS BRUSLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SELLARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-214-9353
Mailing Address - Street 1:PO BOX 679632
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-9632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4463 HWY 1 SOUTH
Practice Address - Street 2:
Practice Address - City:BRUSLY
Practice Address - State:LA
Practice Address - Zip Code:70767-0000
Practice Address - Country:US
Practice Address - Phone:225-771-8012
Practice Address - Fax:225-771-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441376Medicaid
LACJ4680OtherMEDICAID RR
LA4281650009Medicare NSC
LA5C822Medicare PIN