Provider Demographics
NPI:1508514241
Name:SOUTHERN URGENT CARE, LLC
Entity Type:Organization
Organization Name:SOUTHERN URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-545-6994
Mailing Address - Street 1:1806 LINDBERG DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-503-9162
Mailing Address - Fax:
Practice Address - Street 1:1806 LINDBERG DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-503-9162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care