Provider Demographics
NPI:1710309828
Name:MHM URGENT CARE HAMMOND, LLC
Entity Type:Organization
Organization Name:MHM URGENT CARE HAMMOND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-831-3112
Mailing Address - Street 1:3510 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3531
Mailing Address - Country:US
Mailing Address - Phone:504-831-3112
Mailing Address - Fax:504-831-3778
Practice Address - Street 1:2741 W THOMAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2838
Practice Address - Country:US
Practice Address - Phone:504-831-3112
Practice Address - Fax:504-831-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2355937Medicaid
LA338623OtherMEDICARE ID