Provider Demographics
NPI:1922548841
Name:SEDALIA URGENT CARE LLC
Entity Type:Organization
Organization Name:SEDALIA URGENT CARE LLC
Other - Org Name:AMERICAN FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-951-1091
Mailing Address - Street 1:115 W BROADWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5708
Mailing Address - Country:US
Mailing Address - Phone:660-951-1091
Mailing Address - Fax:660-951-1092
Practice Address - Street 1:115 W BROADWAY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5708
Practice Address - Country:US
Practice Address - Phone:660-951-1091
Practice Address - Fax:660-951-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care