Healthcare Provider Details

I. General information

NPI: 1407262074
Provider Name (Legal Business Name): URGENT CARE OF ST BERNARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 W JUDGE PEREZ DR
CHALMETTE LA
70043-1803
US

IV. Provider business mailing address

8717 W JUDGE PEREZ DR
CHALMETTE LA
70043-1803
US

V. Phone/Fax

Practice location:
  • Phone: 504-393-2273
  • Fax: 504-393-2744
Mailing address:
  • Phone: 504-393-2273
  • Fax: 504-393-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024334
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS T MEHAFFIE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 504-393-2273