Provider Demographics
NPI:1790156032
Name:BYRON CORNELIUS GLENN
Entity Type:Organization
Organization Name:BYRON CORNELIUS GLENN
Other - Org Name:CAPE URGENT CARE & FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:C
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-332-8400
Mailing Address - Street 1:1353 N MOUNT AUBURN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1727
Mailing Address - Country:US
Mailing Address - Phone:573-332-8400
Mailing Address - Fax:573-332-8151
Practice Address - Street 1:1353 N MOUNT AUBURN RD
Practice Address - Street 2:SUITE B
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1727
Practice Address - Country:US
Practice Address - Phone:573-332-8400
Practice Address - Fax:573-332-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care