Organization
ICARE PRIMARY CARE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIK CHRISTIAN PETERSEN D.O. (CHIEF MEDICAL OFFICER)
(816) 875-4325
Entity
Organization
Contact information
Practice address
550 RUSH CREEK PKWY, SUITE B, LIBERTY, MO 64068-9608
(816) 875-4325
(636) 237-8053
Mailing address
550 RUSH CREEK PKWY, SUITE B, LIBERTY, MO 64068-9608
(816) 875-4325
(636) 237-8053
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
FL001411027
MO
Other
Enumeration date
12/05/2014
Last updated
12/05/2014
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