| Organization Name: | DRX - FC MANAGEMENT 005, LLC |
| NPI Number: | 1326336702 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BERNIE C RANCHERO (REGIONAL MEDICAL DIRECTOR) |
| Mailing Address: | 11648 Manchester Rd Des Peres |
| State: | MO US |
| Postal Code: | 631314612 |
| Phone Number: | 3148211099 |
| Fax Number: | 3143950945 |
| NPI Enumeration Date: | 07/19/2011 |
| NPI Last Update Date: | 07/19/2011 |
| 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: | |