MEDICARE: VETERANS ADVANTAGE URGENT CARE,INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	171100000X	Acupuncturist
3	213E00000X	Podiatrist
4	261QP2000X	Physical Therapy Clinic/Center
5	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1639782121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERANS ADVANTAGE URGENT CARE,INC

Provider Business Mailing Address
First Line	:	9151 N SWAN CIR
Second Line	:
City	:	BRENTWOOD
State	:	MO
Zip	:	63144-1165
Country	:	US
Telephone Number	:	314-696-2090
Fax Number	:	314-261-0232

Provider Business Practice Location Address
First Line	:	1901 WASHINGTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1623
Country	:	US
Telephone Number	:	314-696-2090
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NICOLE LATOSICA JENKINS
Credential	:
Telephone Number	:	314-696-2090

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/24/2023

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