Healthcare Provider Details

I. General information

NPI: 1134843451
Provider Name (Legal Business Name): PSYCHIATRIC URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 STATE ROUTE 162
MARYVILLE IL
62062-8530
US

IV. Provider business mailing address

6805 STATE ROUTE 162 STE 201
MARYVILLE IL
62062-8530
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-5019
  • Fax: 618-288-5059
Mailing address:
  • Phone: 618-288-5019
  • Fax: 618-288-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANJAY K NIGAM
Title or Position: PHYSICIAN
Credential: MD
Phone: 618-288-5019