Healthcare Provider Details

I. General information

NPI: 1013341676
Provider Name (Legal Business Name): MEDEXPRESS URGENT CARE - NEW JERSEY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 ROUTE 38
CHERRY HILL NJ
08002-1852
US

IV. Provider business mailing address

1001 CONSOL ENERGY DR
CANONSBURG PA
15317-6506
US

V. Phone/Fax

Practice location:
  • Phone: 856-779-0783
  • Fax: 856-779-0694
Mailing address:
  • Phone: 304-225-2500
  • Fax: 724-743-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY G BUGIN
Title or Position: VP OF PAYOR CONTRACTING
Credential:
Phone: 304-225-2500