MEDICARE: OUR 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	:	1831666890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	2893 VETERANS MEMORIAL PKWY
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3526
Country	:	US
Telephone Number	:	636-887-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-1647
Country	:	US
Telephone Number	:	314-690-5078
Fax Number	:	314-755-1824

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH SEIBEL
Credential	:
Telephone Number	:	636-887-3020

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	12/02/2019

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