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General NPI Number Information
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NPI Number | 1346633831
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Entity Type | Organization
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Legal Business Name | MINUTE MED CLINIC - PONT DE MOUTON LLC
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 104 BANISTER COURT SUITE 1C
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City | LAFAYETTE
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State | LA
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Zip | 70507
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Country | US
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Telephone | 337-456-3519
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Fax | 337-205-6272
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Provider Business Mailing Address
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Address Line | 2851 JOHNSTON ST
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City | LAFAYETTE
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State | LA
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Zip | 70503-3243
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Country | US
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Telephone | 337-456-3519
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Fax | 337-205-6272
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | MR. DAVID C REESE
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Credential | FNP
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Telephone | 337-456-3519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | LA
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