Provider Demographics
NPI:1639257769
Name:URGENT CARE AND FAMILY MEDICINE CLINIC
Entity Type:Organization
Organization Name:URGENT CARE AND FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIYID
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-755-0095
Mailing Address - Street 1:4802 JONES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1527
Mailing Address - Country:US
Mailing Address - Phone:225-755-0096
Mailing Address - Fax:225-755-5920
Practice Address - Street 1:4802 JONES CREEK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1527
Practice Address - Country:US
Practice Address - Phone:225-755-0095
Practice Address - Fax:225-755-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2018-11-14
Deactivation Date:2018-10-01
Deactivation Code:
Reactivation Date:2018-11-07
Provider Licenses
StateLicense IDTaxonomies
LA10247R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1449105Medicaid