Provider Demographics
NPI:1598049751
Name:METRO MEDICAL URGENT CARE
Entity Type:Organization
Organization Name:METRO MEDICAL URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAWED
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-397-6785
Mailing Address - Street 1:11115 NEW HALLS FERRY RD
Mailing Address - Street 2:# 300
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11115 NEW HALLS FERRY RD
Practice Address - Street 2:# 201
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-7613
Practice Address - Country:US
Practice Address - Phone:314-397-6785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty