Healthcare Provider Details

I. General information

NPI: 1629434253
Provider Name (Legal Business Name): MEDEXPRESS URGENT CARE, INC - WEST VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GOFF MOUNTAIN RD
CROSS LANES WV
25313-6602
US

IV. Provider business mailing address

423 FORTRESS BLVD
MORGANTOWN WV
26508-1351
US

V. Phone/Fax

Practice location:
  • Phone: 304-769-0301
  • Fax: 304-769-0860
Mailing address:
  • Phone: 304-225-2500
  • Fax: 304-985-6350

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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIM BUGIN
Title or Position: VP PAYOR CONTRACTING
Credential:
Phone: 304-225-2500