Healthcare Provider Details

I. General information

NPI: 1003971417
Provider Name (Legal Business Name): MEDEXPRESS URGENT CARE LLC - GREENSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 STATE ROUTE 30 STE 300
GREENSBURG PA
15601-7554
US

IV. Provider business mailing address

PO BOX 719
DELLSLOW WV
26531-0719
US

V. Phone/Fax

Practice location:
  • Phone: 724-836-3028
  • Fax: 724-836-3029
Mailing address:
  • Phone: 304-985-3627
  • Fax: 304-985-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency 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: TIMOTHY BUGIN
Title or Position: VP OF PAYOR CONTRACTING
Credential:
Phone: 304-225-2500