Provider Demographics
NPI:1578625182
Name:HOUMA URGENT CARE LLC
Entity Type:Organization
Organization Name:HOUMA URGENT CARE LLC
Other - Org Name:HOUMA URGENT CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-580-9996
Mailing Address - Street 1:131 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2767
Mailing Address - Country:US
Mailing Address - Phone:985-580-9996
Mailing Address - Fax:985-580-9987
Practice Address - Street 1:131 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2767
Practice Address - Country:US
Practice Address - Phone:985-580-9996
Practice Address - Fax:985-580-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
LAPHY.005311-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1271675Medicaid
2035220OtherPK