1164132403 NPI number — PCP URGENT CARE HOLDINGS LLC

Table of content: (NPI 1164132403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164132403 NPI number — PCP URGENT CARE HOLDINGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PCP URGENT CARE HOLDINGS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PATIENT PLUS URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164132403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7515 JEFFERSON HWY # 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806-8308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-224-8690
Provider Business Mailing Address Fax Number:
225-615-7704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7353 JEFFERSON HWY BLDG 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-8286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-442-0500
Provider Business Practice Location Address Fax Number:
225-364-2276
Provider Enumeration Date:
11/28/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRESLEY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
CHIEF STRATEGY OFFICER
Authorized Official Telephone Number:
225-663-6827

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2406159 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".