Healthcare Provider Details

I. General information

NPI: 1063457588
Provider Name (Legal Business Name): EXPRESS MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 GOVERNMENT STREET
OCEAN SPRINGS MS
39564
US

IV. Provider business mailing address

2331 GOVERNMENT STREET
OCEAN SPRINGS MS
39564
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-4089
  • Fax: 228-872-8872
Mailing address:
  • Phone: 228-872-4089
  • Fax: 228-872-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number06349/11.1
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL H. ZUBER
Title or Position: OWNER
Credential:
Phone: 228-872-4089