Healthcare Provider Details

I. General information

NPI: 1548458029
Provider Name (Legal Business Name): EXPRESS MEDICAL STAFFING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8517 HIGHWAY 165
COLUMBIA LA
71418-4324
US

IV. Provider business mailing address

PO BOX 388
GRAYSON LA
71435-0388
US

V. Phone/Fax

Practice location:
  • Phone: 318-649-3565
  • Fax: 318-649-5299
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License NumberPCA 14020
License Number StateLA

VIII. Authorized Official

Name: REBA BRISCOE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 318-649-3565