1235227422 NPI number — MEDEXPRESS URGENT CARE, LLC - ADAMS TOWNSHIP

Table of content: (NPI 1235227422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235227422 NPI number — MEDEXPRESS URGENT CARE, LLC - ADAMS TOWNSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDEXPRESS URGENT CARE, LLC - ADAMS 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:
1235227422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2010
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:
6998 CRIDER RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MARS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16046-2390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-778-3627
Provider Business Practice Location Address Fax Number:
724-778-3630
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUGIN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PAYOR CONTRACTING
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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