Healthcare Provider Details

I. General information

NPI: 1386950251
Provider Name (Legal Business Name): BROADWAY URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 W BROADWAY SUITE 100
COLUMBIA MO
65203-1111
US

IV. Provider business mailing address

2003 W BROADWAY SUITE 100
COLUMBIA MO
65203-1111
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-5880
  • Fax:
Mailing address:
  • Phone: 573-777-5880
  • Fax:

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: SHIRLEY DUFF
Title or Position: CFO
Credential:
Phone: 573-777-5880