Provider Demographics
NPI:1659562411
Name:CHALMETTE URGENT MEDICAL CARE LLC
Entity Type:Organization
Organization Name:CHALMETTE URGENT MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-309-8928
Mailing Address - Street 1:619 E JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-5260
Mailing Address - Country:US
Mailing Address - Phone:504-309-8928
Mailing Address - Fax:504-309-8954
Practice Address - Street 1:619 E JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-5260
Practice Address - Country:US
Practice Address - Phone:504-309-8928
Practice Address - Fax:504-309-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD02229208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
146661234OtherUNITED HEALTHCARE
LA146661234COtherBLUECROSS BLUE SHIELD
LA=========OtherHUMANA
LAG07810Medicare UPIN
LA=========OtherHUMANA
LA146661234COtherBLUECROSS BLUE SHIELD