Forever Young

NPI #1619333481 in Webb City, Missouri

Provider Information

NPI Number: 1619333481
Entity Type: Organization
Organization Name: Forever Young
Subpart: Yes (part of a larger organization)
Parent Organization: PROFESSIONAL URGENT CARE, LLC
Primary Specialty: Clinic/Center
Enumeration Date: Jan 11, 2016
Last Updated: Jan 11, 2016

Practice Location

Address: 6055 N MAIN STREET RD
City: Webb City
State: Missouri
ZIP Code: 64870-7219
Phone: (417) 206-0900

Authorized Official

Name: DR. DAVID LARUE, DO
Title: MEDICAL DIRECTOR
Phone: (417) 206-0900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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