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NPI Code Detail

MEDICARE: EXPRESS MED OF KING OF PRUSSIA LLC

MEDICARE: EXPRESS MED OF KING OF PRUSSIA LLC
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
1261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1710227293
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXPRESS MED OF KING OF PRUSSIA LLC
Provider Business Mailing Address
First Line : 322 EDGEHILL RD
Second Line :
City : WAYNE
State : PA
Zip : 19087-4716
Country : US
Telephone Number : 610-401-8368
Fax Number :
Provider Business Practice Location Address
First Line : 107 TOWN CENTER RD
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-2330
Country : US
Telephone Number : 610-401-8368
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MICHAEL MCCORMICK
Credential : D.O.
Telephone Number : 256-483-8447
Provider Enumeration Date : 02/21/2013
Last Update Date : 02/21/2013

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Directions to “EXPRESS MED OF KING OF PRUSSIA LLC ” Practice Location

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