MEDICARE: MIDWEST TOTAL URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1427766641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST TOTAL URGENT CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 2316
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63702-2316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 N MOUNT AUBURN RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-1722
Country	:	US
Telephone Number	:	573-768-6986
Fax Number	:	949-655-8621

Authorized Official
Title or Position	:	OWNER
Name	:	LANDON BESAND
Credential	:
Telephone Number	:	573-768-6986

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/07/2022

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