Provider Demographics
NPI:1245648161
Name:NORTHLAND URGENT CARE LLC
Entity type:Organization
Organization Name:NORTHLAND URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-452-4488
Mailing Address - Street 1:5601 NE ANTIOCH RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2300
Mailing Address - Country:US
Mailing Address - Phone:816-452-4488
Mailing Address - Fax:816-452-4491
Practice Address - Street 1:5601 NE ANTIOCH RD
Practice Address - Street 2:SUITE 6
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-2300
Practice Address - Country:US
Practice Address - Phone:816-452-4488
Practice Address - Fax:816-452-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care