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General NPI Number Information
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NPI Number | 1669849642
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Entity Type | Organization
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Legal Business Name | THE URGENT CARE
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 148 WALL BLVD
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City | GRETNA
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State | LA
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Zip | 70056-7107
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Country | US
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Telephone | 504-393-2273
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Fax | 504-393-2744
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Provider Business Mailing Address
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Address Line | 148 WALL BLVD
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City | GRETNA
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State | LA
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Zip | 70056-7107
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Country | US
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Telephone | 504-393-2273
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Fax | 504-393-2744
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DOUGLAS TERRY MEHAFFIE
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Credential | M.D.
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Telephone | 504-393-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | LA
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