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General NPI Number Information
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NPI Number | 1134843451
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC URGENT CARE LLC
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 6805 STATE ROUTE 162
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City | MARYVILLE
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State | IL
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Zip | 62062-8530
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Country | US
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Telephone | 618-288-5019
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Fax | 618-288-5059
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Provider Business Mailing Address
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Address Line | 6805 STATE ROUTE 162 STE 201
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City | MARYVILLE
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State | IL
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Zip | 62062-8530
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Country | US
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Telephone | 618-288-5019
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Fax | 618-288-5059
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SANJAY K NIGAM
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Credential | MD
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Telephone | 618-288-5019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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