Healthcare Provider Details

I. General information

NPI: 1902815863
Provider Name (Legal Business Name): OUR URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W PEARCE BLVD
WENTZVILLE MO
63385-1020
US

IV. Provider business mailing address

P O BOX 795216
ST LOUIS MO
63179
US

V. Phone/Fax

Practice location:
  • Phone: 252-813-9104
  • Fax:
Mailing address:
  • Phone: 252-813-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOGAN MCCALL
Title or Position: PRESIDENT
Credential:
Phone: 252-813-9104