Healthcare Provider Details

I. General information

NPI: 1164831806
Provider Name (Legal Business Name): EXPRESS MED AT SALEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N BROADWAY
SALEM NH
03079-2127
US

IV. Provider business mailing address

55 BRIDGE ST
MANCHESTER NH
03101-1603
US

V. Phone/Fax

Practice location:
  • Phone: 603-898-0961
  • Fax: 603-898-0964
Mailing address:
  • Phone: 603-232-4513
  • Fax: 603-232-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS VAILAS
Title or Position: OWNER
Credential:
Phone: 603-731-5589