Healthcare Provider Details

I. General information

NPI: 1790976447
Provider Name (Legal Business Name): EXPRESS MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 1ST AVE
LAWRENCEBURG TN
38464-2762
US

IV. Provider business mailing address

1276 1ST AVE
LAWRENCEBURG TN
38464-2762
US

V. Phone/Fax

Practice location:
  • Phone: 931-766-7056
  • Fax: 931-766-7057
Mailing address:
  • Phone: 931-766-7056
  • Fax: 931-766-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAPN12850
License Number StateTN

VIII. Authorized Official

Name: SHEILA K MCLAIN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 931-766-7056