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General NPI Number Information
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NPI Number | 1346493525
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Entity Type | Organization
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Legal Business Name | TCHEFUNCTA URGENT CARE, INC.
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Dates
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Enumeration Date | 10/31/2008
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 71338 HWY 21 SUITE 100
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City | COVINGTON
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State | LA
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Zip | 70433
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Country | US
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Telephone | 985-809-8868
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Fax | 985-809-8838
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Provider Business Mailing Address
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Address Line | 71338 HWY 21 SUITE 100
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City | COVINGTON
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State | LA
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Zip | 70433
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Country | US
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Telephone | 985-809-8868
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Fax | 985-809-8838
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS F MATTA II
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Credential | MD
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Telephone | 985-809-8868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | MD.019575
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License Number State | LA
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