Healthcare Provider Details

I. General information

NPI: 1336548734
Provider Name (Legal Business Name): MEDEXPRESS URGENT CARE, PC - MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N WEST AVE
JACKSON MI
49202-2050
US

IV. Provider business mailing address

1001 CONSOL ENERGY DR
CANONSBURG PA
15317-6506
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-0384
  • Fax: 517-768-0386
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. TIM BUGIN
Title or Position: VP PAYOR CONTRACTING
Credential:
Phone: 304-225-2500