Provider Demographics
NPI:1528021565
Name:URBANA MEDICAL CLINIC, L.L.C.
Entity Type:Organization
Organization Name:URBANA MEDICAL CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-993-1999
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:MO
Mailing Address - Zip Code:65767-0127
Mailing Address - Country:US
Mailing Address - Phone:417-993-1999
Mailing Address - Fax:417-993-1806
Practice Address - Street 1:311 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:MO
Practice Address - Zip Code:65767-9101
Practice Address - Country:US
Practice Address - Phone:417-993-1999
Practice Address - Fax:417-993-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty