1164962171 NPI number — HEALTHCARE EXPRESS, LLP

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 1164962171 NPI number — HEALTHCARE EXPRESS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE EXPRESS, LLP
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:
1164962171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3515 RICHMOND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-0711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-831-7270
Provider Business Mailing Address Fax Number:
903-793-0496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23150 I-30 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYANT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-888-9047
Provider Business Practice Location Address Fax Number:
501-213-0531
Provider Enumeration Date:
02/24/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
903-791-9355

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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