Healthcare Provider Details

I. General information

NPI: 1396792495
Provider Name (Legal Business Name): RIVERPARK AFTER HOURS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FRONT ST
VIDALIA LA
71373-2836
US

IV. Provider business mailing address

107 FRONT ST
VIDALIA LA
71373-2836
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-2222
  • Fax: 318-336-6064
Mailing address:
  • Phone: 318-336-2222
  • Fax: 318-336-6064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberMD14808R
License Number StateLA

VIII. Authorized Official

Name: IBRAHIM SEKI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 318-336-2222