=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639252489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUICK CARE OF RUSTON, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1929 FARMERVILLE HWY
-----------------------------------------------------
City | RUSTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-255-3762
-----------------------------------------------------
Fax | 318-255-8820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1381
-----------------------------------------------------
City | RUSTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71273-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-255-0161
-----------------------------------------------------
Fax | 318-255-8820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DONNA SATERFIEL
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 318-255-3762
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 020374
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 06019R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | AP03105
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | AP03480
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | AP04283
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | AP04762
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | AP03197
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------