1013419522 NPI number — MEDEXPRESS URGENT CARE, PC - TENNESSEE

Table of content: (NPI 1013419522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013419522 NPI number — MEDEXPRESS URGENT CARE, PC - TENNESSEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDEXPRESS URGENT CARE, PC - TENNESSEE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDEXPRESS - ORNL OAK RIDGE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013419522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 CONSOL ENERGY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANONSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-6506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-225-2500
Provider Business Mailing Address Fax Number:
724-743-1133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BETHEL VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-8050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-574-9355
Provider Business Practice Location Address Fax Number:
865-574-9353
Provider Enumeration Date:
03/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GALL
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PAYOR CONTRACTING
Authorized Official Telephone Number:
304-225-2500

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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