Healthcare Provider Details

I. General information

NPI: 1922548841
Provider Name (Legal Business Name): SEDALIA URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W BROADWAY BLVD STE 100
SEDALIA MO
65301-5708
US

IV. Provider business mailing address

115 W BROADWAY BLVD STE 100
SEDALIA MO
65301-5708
US

V. Phone/Fax

Practice location:
  • Phone: 660-951-1091
  • Fax: 660-951-1092
Mailing address:
  • Phone: 660-951-1091
  • Fax: 660-951-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE GUEVARA
Title or Position: OWNER
Credential:
Phone: 660-951-1091