Provider Demographics
NPI:1003150608
Name:RIVER RIDGE URGENT CARE, LLC
Entity Type:Organization
Organization Name:RIVER RIDGE URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-846-3150
Mailing Address - Street 1:3510 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3531
Mailing Address - Country:US
Mailing Address - Phone:504-831-3112
Mailing Address - Fax:504-831-3778
Practice Address - Street 1:9605 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-2550
Practice Address - Country:US
Practice Address - Phone:504-739-9494
Practice Address - Fax:504-739-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA269201OtherMEDICARE ID
LA2352172Medicaid