Provider Demographics
NPI:1447934187
Name:GULF COAST URGENT CARE
Entity type:Organization
Organization Name:GULF COAST URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-842-1397
Mailing Address - Street 1:PO BOX 4755
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4755
Mailing Address - Country:US
Mailing Address - Phone:337-436-7216
Mailing Address - Fax:337-436-7217
Practice Address - Street 1:404 E PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8507
Practice Address - Country:US
Practice Address - Phone:337-436-7216
Practice Address - Fax:337-436-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty