Healthcare Provider Details

I. General information

NPI: 1114637071
Provider Name (Legal Business Name): PCP URGENT CARE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 OAK PLAZA BLVD.
BRUSLY LA
70719
US

IV. Provider business mailing address

7515 JEFFERSON HWY # 246
BATON ROUGE LA
70806-8308
US

V. Phone/Fax

Practice location:
  • Phone: 225-877-3700
  • Fax: 225-256-4583
Mailing address:
  • Phone: 225-224-8690
  • Fax: 225-615-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN EDWARD PRESLEY
Title or Position: CHIEF STRATEGY OFFICER
Credential: PA-C
Phone: 225-663-6827