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General NPI Number Information
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NPI Number | 1336592856
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Entity Type | Organization
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Legal Business Name | MEDEXPRESS URGENT CARE, PC - MICHIGAN
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 3100 PLAINFIELD AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3261
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Country | US
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Telephone | 616-447-7851
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Fax | 616-447-9360
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Provider Business Mailing Address
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Address Line | 1001 CONSOL ENERGY DR
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City | CANONSBURG
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State | PA
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Zip | 15317-6506
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Country | US
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Telephone | 304-225-2500
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Fax | 724-743-1133
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Authorized Official
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Title or Position | VP PAYOR CONTRACTING
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Name | TIM BUGIN
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Credential |
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Telephone | 304-225-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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