Provider Demographics
NPI:1316246408
Name:STARBRIGHT PEDIATRIC URGENT CARE
Entity type:Organization
Organization Name:STARBRIGHT PEDIATRIC URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GESKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-757-8808
Mailing Address - Street 1:10608 COURSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4015
Mailing Address - Country:US
Mailing Address - Phone:225-757-8808
Mailing Address - Fax:225-757-8875
Practice Address - Street 1:5428 ODONOVAN DR
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4364
Practice Address - Country:US
Practice Address - Phone:225-757-8808
Practice Address - Fax:225-757-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022667261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care