=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790512234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNTAMED HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2024
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5525 SUPERIOR DR STE C3
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-8052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-496-1921
-----------------------------------------------------
Fax | 225-217-8899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5525 SUPERIOR DR STE C3
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-8052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-496-1921
-----------------------------------------------------
Fax | 225-217-8899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP/OWNER
-----------------------------------------------------
Name | MR. MATTHEW NAQUIN
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 225-413-2265
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------