1811141005 NPI number — MEDEXPRESS URGENT CARE, PC - MOON TOWNSHIP

Table of content: (NPI 1811141005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811141005 NPI number — MEDEXPRESS URGENT CARE, PC - MOON TOWNSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDEXPRESS URGENT CARE, PC - MOON TOWNSHIP
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:
1811141005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 719
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELLSLOW
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26531-0719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-985-3627
Provider Business Mailing Address Fax Number:
304-985-3630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8702 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOON TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15108-4209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-299-3627
Provider Business Practice Location Address Fax Number:
304-299-3623
Provider Enumeration Date:
11/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BUGIN
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
VP PAYOR CONTRACTING & REIMBURSEMEN
Authorized Official Telephone Number:
304-225-2500

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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