1639234495 NPI number — AHS WALK IN CLINIC INC

Table of content: (NPI 1639234495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639234495 NPI number — AHS WALK IN CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHS WALK IN CLINIC INC
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:
SOUTHSTAR 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:
1639234495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6011 AMBASSADOR CAFFERY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70592-5170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-234-9925
Provider Business Mailing Address Fax Number:
337-237-5211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6011 AMBASSADOR CAFFERY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70592-5170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-234-9925
Provider Business Practice Location Address Fax Number:
337-235-3357
Provider Enumeration Date:
12/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PREJEAN
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT SPECIALIST
Authorized Official Telephone Number:
337-202-0720

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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