Provider Demographics
NPI:1831645191
Name:BREAUX BRIDGE MM LLC
Entity Type:Organization
Organization Name:BREAUX BRIDGE MM LLC
Other - Org Name:MINUTE MED CLINIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-781-1630
Mailing Address - Street 1:2851 JOHNSTON ST
Mailing Address - Street 2:PMB 299
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3243
Mailing Address - Country:US
Mailing Address - Phone:337-456-6851
Mailing Address - Fax:337-504-4798
Practice Address - Street 1:1451 E BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517
Practice Address - Country:US
Practice Address - Phone:337-456-6851
Practice Address - Fax:337-504-4798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1750638391
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490725Medicaid
LAG45552Medicare UPIN