Healthcare Provider Details

I. General information

NPI: 1932372307
Provider Name (Legal Business Name): LEBONHEUR URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 GOODMAN RD SUITE 2
OLIVE BRANCH MS
38654-7902
US

IV. Provider business mailing address

6400 SHELBY VIEW DR SUITE 101
MEMPHIS TN
38134-7659
US

V. Phone/Fax

Practice location:
  • Phone: 662-893-9877
  • Fax: 662-893-9828
Mailing address:
  • Phone: 901-516-1489
  • Fax: 901-380-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULOY RAYMER
Title or Position: DIRECTOR
Credential:
Phone: 901-516-4176