Provider Demographics
NPI:1679959282
Name:DUTCHTOWN URGENT CARE LLC
Entity Type:Organization
Organization Name:DUTCHTOWN URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:NANCE
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-938-2078
Mailing Address - Street 1:13201 HWY 73
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734
Mailing Address - Country:US
Mailing Address - Phone:225-673-2088
Mailing Address - Fax:225-673-2080
Practice Address - Street 1:13201 HWY 73
Practice Address - Street 2:SUITE 102
Practice Address - City:GEISMAR
Practice Address - State:LA
Practice Address - Zip Code:70734
Practice Address - Country:US
Practice Address - Phone:225-673-2088
Practice Address - Fax:225-673-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty