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General NPI Number Information
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NPI Number | 1407245954
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Entity Type | Organization
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Legal Business Name | FIRST CARE EXPRESS CARE LLC
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 10 EMERALD TER STE C
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City | SWANSEA
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State | IL
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Zip | 62226-2310
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Country | US
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Telephone | 618-235-6780
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Fax | 618-235-6740
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Provider Business Mailing Address
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Address Line | 10 EMERALD TER STE C
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City | SWANSEA
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State | IL
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Zip | 62226-2310
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Country | US
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Telephone | 618-235-6780
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Fax | 618-235-6740
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KHAJA G MOHSIN
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Credential | MD
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Telephone | 618-235-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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