Healthcare Provider Details

I. General information

NPI: 1992418461
Provider Name (Legal Business Name): LITTLE TREE PEDIATRIC URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CORPORATE LAKE DR
COLUMBIA MO
65203-7172
US

IV. Provider business mailing address

206 CORPORATE LAKE DR
COLUMBIA MO
65203-7172
US

V. Phone/Fax

Practice location:
  • Phone: 573-814-1170
  • Fax: 573-530-1037
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM WHEELER
Title or Position: OWNER
Credential: MD
Phone: 573-814-1170