Healthcare Provider Details

I. General information

NPI: 1508389859
Provider Name (Legal Business Name): MEDEXPRESS URGENT CARE CONNECTICUT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 WASHINGTON STREET
MIDDLETOWN CT
06457-2904
US

IV. Provider business mailing address

1001 CONSOL ENERGY DR
CANONSBURG PA
15317-6506
US

V. Phone/Fax

Practice location:
  • Phone: 860-343-1685
  • Fax: 860-343-1826
Mailing address:
  • Phone: 304-225-2500
  • Fax: 724-743-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BRETT GALL
Title or Position: DIRECTOR PAYOR CONTRACTING
Credential:
Phone: 304-225-2500