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General NPI Number Information
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NPI Number | 1669627626
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Entity Type | Organization
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Legal Business Name | FAIRWAY MEDICAL URGENT CARE LLC
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 70340 HIGHWAY 21 STE A
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City | COVINGTON
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State | LA
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Zip | 70433-7119
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Country | US
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Telephone | 985-809-8989
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2223
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City | MANDEVILLE
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State | LA
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Zip | 70470-2223
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Country | US
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Telephone | 985-809-8989
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID GUZAN
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Credential |
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Telephone | 985-801-3010
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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 |
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License Number State |
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