Provider Demographics
NPI:1639234495
Name:AHS WALK IN CLINIC INC
Entity Type:Organization
Organization Name:AHS WALK IN CLINIC INC
Other - Org Name:SOUTHSTAR URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PREJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:337-202-0720
Mailing Address - Street 1:6011 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5170
Mailing Address - Country:US
Mailing Address - Phone:337-234-9925
Mailing Address - Fax:337-237-5211
Practice Address - Street 1:6011 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5170
Practice Address - Country:US
Practice Address - Phone:337-234-9925
Practice Address - Fax:337-235-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty