Healthcare Provider Details

I. General information

NPI: 1548682578
Provider Name (Legal Business Name): MEDEXPRESS LITTLEVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369A GEORGE WALLACE HWY
RUSSELLVILLE AL
35654-3281
US

IV. Provider business mailing address

1369A GEORGE WALLACE HWY
RUSSELLVILLE AL
35654-3281
US

V. Phone/Fax

Practice location:
  • Phone: 256-331-9700
  • Fax: 256-331-2615
Mailing address:
  • Phone: 256-331-9700
  • Fax: 256-331-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLEN M JONES
Title or Position: CEO
Credential:
Phone: 256-356-9532