Provider Demographics
NPI: | 1164814570 |
---|---|
Name: | ALL ACCESS WALK IN CLINIC |
Entity Type: | Organization |
Organization Name: | ALL ACCESS WALK IN CLINIC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CO-OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SABRINA |
Authorized Official - Middle Name: | CHAISSON |
Authorized Official - Last Name: | FICK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 985-709-0311 |
Mailing Address - Street 1: | 855 BELANGER ST |
Mailing Address - Street 2: | SUITE 106 |
Mailing Address - City: | HOUMA |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70360-4463 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 985-709-0311 |
Mailing Address - Fax: | 985-262-4082 |
Practice Address - Street 1: | 855 BELANGER ST |
Practice Address - Street 2: | SUITE 106 |
Practice Address - City: | HOUMA |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70360-4463 |
Practice Address - Country: | US |
Practice Address - Phone: | 985-709-0311 |
Practice Address - Fax: | 985-262-4082 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-02-22 |
Last Update Date: | 2015-02-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | OC-21357 | 261QU0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |