Healthcare Provider Details

I. General information

NPI: 1871893339
Provider Name (Legal Business Name): URGENT CARE OF SLIDELL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 GATEWAY DR STE B
SLIDELL LA
70461-5540
US

IV. Provider business mailing address

202 VILLAGE CIR STE 1
SLIDELL LA
70458-5374
US

V. Phone/Fax

Practice location:
  • Phone: 985-661-8851
  • Fax: 985-661-8854
Mailing address:
  • Phone: 985-726-9605
  • Fax: 985-726-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE A GALLOWAY
Title or Position: PRESIDENT
Credential:
Phone: 985-726-9605