Provider Demographics
NPI:1396746111
Name:DENHAM SPRINGS URGENT CARE LLC
Entity type:Organization
Organization Name:DENHAM SPRINGS URGENT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-791-0002
Mailing Address - Street 1:DEPT 960139
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0139
Mailing Address - Country:US
Mailing Address - Phone:877-485-4474
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:1585 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5201
Practice Address - Country:US
Practice Address - Phone:225-791-0002
Practice Address - Fax:225-791-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA.207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACK8720OtherRAILROAD MCARE
LA1948403Medicaid
LA1948403Medicaid
LACK8720OtherRAILROAD MCARE