| Organization Name: | COASTAL URGENT CARE, LLC |
| NPI Number: | 1568601425 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRENNAN DRISCOLL UTER (OWNER/CEO) |
| Mailing Address: | 1124 S Burnside Ave Suite A100 Gonzales |
| State: | LA US |
| Postal Code: | 707374249 |
| Phone Number: | 2256445508 |
| Fax Number: | 2257516686 |
| NPI Enumeration Date: | 02/16/2009 |
| NPI Last Update Date: | 02/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |