MEDICARE: EXPRESS MEDICAL CARE OF WNY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1134459241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS MEDICAL CARE OF WNY PLLC

Provider Business Mailing Address
First Line	:	2949 ELMWOOD AVE
Second Line	:	SUITE 104
City	:	KENMORE
State	:	NY
Zip	:	14217-1356
Country	:	US
Telephone Number	:	716-447-8868
Fax Number	:	716-447-8892

Provider Business Practice Location Address
First Line	:	2949 ELMWOOD AVE
Second Line	:	SUITE 104
City	:	KENMORE
State	:	NY
Zip	:	14217-1356
Country	:	US
Telephone Number	:	716-447-8868
Fax Number	:	716-447-8892

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. JOSEPH R TAKATS III
Credential	:	DO
Telephone Number	:	716-447-8868

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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