| Organization Name: | LAKE URGENT CARE ASCENSION LLC |
| NPI Number: | 1104162221 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVE SELLARS (PRESIDENT) |
| Mailing Address: | 40546 Highway 42 Prairieville |
| State: | LA US |
| Postal Code: | 707695250 |
| Phone Number: | 2257444988 |
| Fax Number: | |
| NPI Enumeration Date: | 12/18/2012 |
| NPI Last Update Date: | 10/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |