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General NPI Number Information
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NPI Number | 1780151381
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Entity Type | Organization
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Legal Business Name | EXPRESS CARE OF CLEVELAND, LLC
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 609 N DAVIS AVE STE 105
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City | CLEVELAND
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State | MS
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Zip | 38732-2379
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Country | US
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Telephone | 662-579-3958
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Fax | 866-962-6149
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Provider Business Mailing Address
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Address Line | 31 COUNTY ROAD 328
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City | OXFORD
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State | MS
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Zip | 38655
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Country | US
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Telephone | 662-816-8999
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GREGORY GOWEN
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Credential |
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Telephone | 662-579-3958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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