Provider Demographics
NPI:1093158990
Name:ST. LOUIS URGENT CARE #2 LLC
Entity Type:Organization
Organization Name:ST. LOUIS URGENT CARE #2 LLC
Other - Org Name:MEDPOST URGENT CARE - ELLISVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF OUTPATIENT SERVICES, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BURTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2153
Mailing Address - Street 1:15420 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3029
Mailing Address - Country:US
Mailing Address - Phone:636-220-9727
Mailing Address - Fax:636-220-9728
Practice Address - Street 1:15420 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-3029
Practice Address - Country:US
Practice Address - Phone:636-220-9727
Practice Address - Fax:636-220-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care