Provider Demographics
NPI:1588081681
Name:STEWART MEDICAL & URGENT CARE, LLC
Entity type:Organization
Organization Name:STEWART MEDICAL & URGENT CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
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:225-686-1166
Practice Address - Street 1:29565 S FROST RD STE C
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754-1903
Practice Address - Country:US
Practice Address - Phone:225-686-1114
Practice Address - Fax:225-686-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2117530Medicaid