Healthcare Provider Details

I. General information

NPI: 1063761310
Provider Name (Legal Business Name): MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 EAST DUBOIS AVENUE
DUBOIS PA
15801
US

IV. Provider business mailing address

423 FORTRESS BLVD
MORGANTOWN WV
26508-1351
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-6164
  • Fax: 814-371-6452
Mailing address:
  • Phone: 763-349-6740
  • 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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOY KIMBALL
Title or Position: CONTRACT MANAGER
Credential:
Phone: 764-349-6740