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General NPI Number Information
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NPI Number | 1215817846
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Entity Type | Organization
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Legal Business Name | EXPRESS CARE MEDICAL GROUP
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 430 ARLINGTON RD STE B
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City | BROOKVILLE
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State | OH
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Zip | 45309-1103
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Country | US
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Telephone | 326-699-6100
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Fax | 326-699-6112
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Provider Business Mailing Address
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Address Line | 430 ARLINGTON RD STE B
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City | BROOKVILLE
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State | OH
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Zip | 45309-1103
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Country | US
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Telephone | 326-699-6100
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Fax | 326-699-6112
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Authorized Official
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Title or Position | OWNER
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Name | SHELBY LYNN GONSALES
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Credential |
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Telephone | 937-867-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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