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General NPI Number Information
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NPI Number | 1740448430
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Entity Type | Organization
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Legal Business Name | MEDEXPRESS URGENT CARE, PLLC - CHARLESTON
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 5430 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-2224
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Country | US
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Telephone | 304-925-3627
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Fax | 304-925-1163
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Provider Business Mailing Address
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Address Line | PO BOX 719
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City | DELLSLOW
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State | WV
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Zip | 26531-0719
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Country | US
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Telephone | 304-985-3627
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Fax | 304-985-3630
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Authorized Official
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Title or Position | VP OF PAYOR CONTRACTING
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Name | TIMOTHY 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 | 01026
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License Number State | WV
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