Healthcare Provider Details

I. General information

NPI: 1639782121
Provider Name (Legal Business Name): VETERANS ADVANTAGE URGENT CARE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 WASHINGTON AVE
SAINT LOUIS MO
63103-1623
US

IV. Provider business mailing address

9151 N SWAN CIR
BRENTWOOD MO
63144-1165
US

V. Phone/Fax

Practice location:
  • Phone: 314-696-2090
  • Fax:
Mailing address:
  • Phone: 314-696-2090
  • Fax: 314-261-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE LATOSICA JENKINS
Title or Position: PRESIDENT
Credential:
Phone: 314-696-2090