Provider Demographics
NPI:1366767832
Name:MD EXPRESS URGENT CARE
Entity type:Organization
Organization Name:MD EXPRESS URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HA
Authorized Official - Middle Name:DO
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-205-4011
Mailing Address - Street 1:5428 ODONOVAN
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4364
Mailing Address - Country:US
Mailing Address - Phone:225-284-8673
Mailing Address - Fax:225-757-8875
Practice Address - Street 1:4242 HWY 19
Practice Address - Street 2:BUILDING 3 SUITE B
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4006
Practice Address - Country:US
Practice Address - Phone:225-284-8673
Practice Address - Fax:225-757-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care