Healthcare Provider Details

I. General information

NPI: 1104984301
Provider Name (Legal Business Name): DOCTORS URGENT CARE OF WEST PLAINS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N KENTUCKY AVE
WEST PLAINS MO
65775-2073
US

IV. Provider business mailing address

314 N KENTUCKY AVE
WEST PLAINS MO
65775-2073
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-1006
  • Fax: 417-256-1007
Mailing address:
  • Phone: 417-256-1006
  • Fax: 417-256-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health 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: MRS. DALI ATILES
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-256-1006