Basic Information
| Provider Information | |||||||||
| NPI: | 1669849642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE URGENT CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 WALL BLVD | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700567107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043932273 | ||||||||
| FaxNumber: | 5043932744 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 WALL BLVD | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700567107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043932273 | ||||||||
| FaxNumber: | 5043932744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2015 | ||||||||
| LastUpdateDate: | 08/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | MEHAFFIE | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | TERRY | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5043932273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.