Basic Information
| Provider Information | |||||||||
| NPI: | 1740319284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRA PHYSICIANS URGENT CARE CENTERS, LLC | ||||||||
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| OtherOrganizationName: | DES PERES URGENT CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1836 LACKLAND HILL PKWY | ||||||||
| Address2: | ATTN CREDENTIALING DEPARTMENT | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631463572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149890300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12161 MANCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631314310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149657800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 11/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | PLISCO | ||||||||
| AuthorizedOfficialFirstName: | IRWIN | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3145790339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | R8E05 | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.