Provider Demographics
NPI:1164150124
Name:PRESTIGE URGENT CARE, INC
Entity Type:Organization
Organization Name:PRESTIGE URGENT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-562-3366
Mailing Address - Street 1:3775 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2133
Mailing Address - Country:US
Mailing Address - Phone:318-562-3366
Mailing Address - Fax:318-562-3416
Practice Address - Street 1:3775 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2133
Practice Address - Country:US
Practice Address - Phone:318-562-3366
Practice Address - Fax:318-562-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care