1679800841 NPI number — EXPRESS CARE WEST, LLC

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 1679800841 NPI number — EXPRESS CARE WEST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXPRESS CARE WEST, LLC
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:
1679800841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 353
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELDEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38826-0353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-231-0487
Provider Business Mailing Address Fax Number:
662-205-4562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1651 N. COLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38801-6931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-269-2230
Provider Business Practice Location Address Fax Number:
662-205-4562
Provider Enumeration Date:
11/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CLEVELAND
Authorized Official First Name:
JOY
Authorized Official Middle Name:
HARDIN
Authorized Official Title or Position:
OWNER, NP
Authorized Official Telephone Number:
662-231-0487

Provider Taxonomy Codes

  • 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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