Organization Name: | ST. LOUIS URGENT CARE #2 LLC |
NPI Number: | 1093158990 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL KYLE BURTNETT (SVP OF OUTPATIENT SERVICES, TENET) |
Mailing Address: | 15420 Manchester Rd Ellisville |
State: | MO US |
Postal Code: | 630113029 |
Phone Number: | 6362209727 |
Fax Number: | 6362209728 |
NPI Enumeration Date: | 04/10/2013 |
NPI Last Update Date: | 05/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |