Provider Demographics
NPI:1346633831
Name:MINUTE MED CLINIC - PONT DE MOUTON LLC
Entity Type:Organization
Organization Name:MINUTE MED CLINIC - PONT DE MOUTON LLC
Other - Org Name:MINUTEMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:337-456-3519
Mailing Address - Street 1:2851 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3243
Mailing Address - Country:US
Mailing Address - Phone:337-456-3519
Mailing Address - Fax:337-205-6272
Practice Address - Street 1:104 BANISTER COURT
Practice Address - Street 2:SUITE 1C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507
Practice Address - Country:US
Practice Address - Phone:337-456-3519
Practice Address - Fax:337-205-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center