Healthcare Provider Details

I. General information

NPI: 1033666151
Provider Name (Legal Business Name): HEALTHCARE EXPRESS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14321 NE 23RD STREET
CHOCTAW OK
73020
US

IV. Provider business mailing address

3515 RICHMOND RD
TEXARKANA TX
75503-0711
US

V. Phone/Fax

Practice location:
  • Phone: 405-342-0255
  • Fax:
Mailing address:
  • Phone: 903-831-7270
  • Fax: 903-793-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY L. REYNOLDS
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 903-791-9355