Provider Demographics
NPI:1346493525
Name:TCHEFUNCTA URGENT CARE, INC.
Entity Type:Organization
Organization Name:TCHEFUNCTA URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:985-809-8868
Mailing Address - Street 1:71338 HWY 21
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-809-8868
Mailing Address - Fax:985-809-8838
Practice Address - Street 1:71338 HWY 21
Practice Address - Street 2:SUITE 100
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-809-8868
Practice Address - Fax:985-809-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.019575261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAE65824Medicare UPIN
LA5DH04Medicare PIN
LA6226600001Medicare NSC