Provider Demographics
NPI:1780863985
Name:NEVADA URGENT CARE, LLC
Entity Type:Organization
Organization Name:NEVADA URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:ASBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:417-667-9000
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-0307
Mailing Address - Country:US
Mailing Address - Phone:417-667-9000
Mailing Address - Fax:417-667-9029
Practice Address - Street 1:111 N ELM ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-2609
Practice Address - Country:US
Practice Address - Phone:417-667-9000
Practice Address - Fax:417-667-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089091332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO39299015OtherBCBS KC
MO624034104Medicaid