Healthcare Provider Details

I. General information

NPI: 1922427806
Provider Name (Legal Business Name): PROFESSIONAL URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 N MAIN STREET RD
WEBB CITY MO
64870-7219
US

IV. Provider business mailing address

6031 N MAIN STREET RD # 395
WEBB CITY MO
64870-7219
US

V. Phone/Fax

Practice location:
  • Phone: 620-762-3809
  • Fax: 620-674-3808
Mailing address:
  • Phone: 417-206-0900
  • Fax: 417-206-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number20000152478
License Number StateMO

VIII. Authorized Official

Name: MRS. ELESHA BROOKE DRAEGER
Title or Position: APRN
Credential: APRN
Phone: 620-762-3809