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General NPI Number Information
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NPI Number | 1013375237
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Entity Type | Organization
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Legal Business Name | MEDEXPRESS RED BAY LLC
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 221 HOSPITAL RD
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City | RED BAY
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State | AL
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Zip | 35582-3858
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Country | US
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Telephone | 256-356-8907
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Fax | 256-356-8903
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Provider Business Mailing Address
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Address Line | 221 HOSPITAL RD
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City | RED BAY
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State | AL
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Zip | 35582-3858
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Country | US
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Telephone | 256-356-8907
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Fax | 256-356-8903
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, REVENUE CYCLE
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Name | VINCENT BONETTI
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Credential |
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Telephone | 256-265-9641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | B3004
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License Number State | AL
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