Provider Demographics
NPI:1306135892
Name:LAKE CHARLES URGENT CARE
Entity type:Organization
Organization Name:LAKE CHARLES URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-990-8000
Mailing Address - Street 1:1905 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5203
Mailing Address - Country:US
Mailing Address - Phone:337-990-8000
Mailing Address - Fax:
Practice Address - Street 1:1905 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5203
Practice Address - Country:US
Practice Address - Phone:337-990-8000
Practice Address - Fax:337-990-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6577880001Medicare NSC
LA5DU45Medicare PIN