Provider Demographics
NPI:1104192434
Name:BEAUMONT URGENT CARE CLINIC
Entity Type:Organization
Organization Name:BEAUMONT URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-394-5044
Mailing Address - Street 1:2097 BEAUMONT DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1412
Mailing Address - Country:US
Mailing Address - Phone:225-394-5044
Mailing Address - Fax:
Practice Address - Street 1:2097 BEAUMONT DR
Practice Address - Street 2:SUITE 4
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1412
Practice Address - Country:US
Practice Address - Phone:225-394-5044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy