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NPI Code Detail

MEDICARE: MEDEXPRESS URGENT CARE TEXAS, P.A.

MEDICARE: MEDEXPRESS URGENT CARE TEXAS, P.A.
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
1207P00000XEmergency Medicine Physician
2261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1720587314
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDEXPRESS URGENT CARE TEXAS, P.A.
Provider Business Mailing Address
First Line : 423 FORTRESS BLVD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-1351
Country : US
Telephone Number : 304-225-2500
Fax Number : 304-985-6350
Provider Business Practice Location Address
First Line : 5700 N TARRANT PKWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-7203
Country : US
Telephone Number : 817-281-0196
Fax Number : 817-281-0197
Authorized Official
Title or Position : CONTRACT MANAGER
Name : JOY KIMBALL
Credential :
Telephone Number : 763-349-6740
Provider Enumeration Date : 02/08/2018
Last Update Date : 05/07/2024

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