1407334352 NPI number — EXPRESS GLOBAL MEDICAL SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407334352 NPI number — EXPRESS GLOBAL MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXPRESS GLOBAL MEDICAL SERVICES
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:
Provider Other Organization Name Type Code:
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:
1407334352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12200 W COLONIAL DR STE 200A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER GARDEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34787-4126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-347-3687
Provider Business Mailing Address Fax Number:
407-264-6594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12200 W COLONIAL DR STE 200A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER GARDEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-347-3687
Provider Business Practice Location Address Fax Number:
407-264-6594
Provider Enumeration Date:
08/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MEDLEY
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
407-325-4269

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ACN420 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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