# GRANITE CITY URGENT CARE WALK-IN CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659861953
- **Authorized official:** MIAN RIZWAN (PROVIDER)
- **Authorized official phone:** (314) 317-0600

## Contact information

- **Practice address:** 2861 MADISON AVE, GRANITE CITY, IL 62040-3614
- **Practice address phone:** (734) 771-8504
- **Practice address fax:** (313) 948-3041
- **Mailing address:** 2861 MADISON AVE, GRANITE CITY, IL 62040-3614
- **Mailing address phone:** (618) 709-7723
- **Mailing address fax:** (618) 709-7706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | MO | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/14/2018
- **Last updated:** 02/10/2021