Provider Demographics
NPI:1912204744
Name:STEWART MEDICAL & URGENT CARE, LLC
Entity Type:Organization
Organization Name:STEWART MEDICAL & URGENT CARE, LLC
Other - Org Name:STEWART FAMILY MEDICINE & AFTER-HOURS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KACIE
Authorized Official - Middle Name:DUPLESSIS
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-686-1114
Mailing Address - Street 1:PO BOX 1567
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-1567
Mailing Address - Country:US
Mailing Address - Phone:225-686-1114
Mailing Address - Fax:225-686-1115
Practice Address - Street 1:29565 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754
Practice Address - Country:US
Practice Address - Phone:225-686-1114
Practice Address - Fax:225-686-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA150261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2117530Medicaid
LA193896OtherMEDICARE PART A
LA5DJ27Medicare PIN