MEDICARE: GLADSTONE 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	:	1598143885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLADSTONE URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	7642 N OAK TRFY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-1751
Country	:	US
Telephone Number	:	816-468-1411
Fax Number	:	816-452-1433

Provider Business Practice Location Address
First Line	:	7642 N OAK TRFY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-1751
Country	:	US
Telephone Number	:	816-468-1411
Fax Number	:	816-468-1433

Authorized Official
Title or Position	:	OWNER
Name	:	TRAVIS MANROE
Credential	:
Telephone Number	:	816-468-1411

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	01/05/2024

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