Organization
ROLLA URGENT CARE LLC
Active
Parent organization
ROLLA URGENT CARE LLC
Other names
Rolla Urgent Care Rural Health Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
ROLLA URGENT CARE LLC
Authorized official
MR. OLUYOMI O OLUSANYA MD (OWNER/DEL. OFFICIAL)
(573) 426-5900
Entity
Organization
Contact information
Practice address
1060 S BISHOP AVE, ROLLA, MO 65401-4411
(573) 426-5900
(573) 426-4466
Mailing address
PO BOX 817, CAPE GIRARDEAU, MO 63702-0817
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2002009086
—
261QR1300X
Rural Health Clinic/Center
—
—
363L00000X
Nurse Practitioner
124268
—
Other
Enumeration date
04/17/2007
Last updated
09/14/2017
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