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General NPI Number Information
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NPI Number | 1780323758
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Entity Type | Organization
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Legal Business Name | EXPRESS CLINICAL SERVICES
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Dates
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Enumeration Date | 05/29/2022
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Last Update Date | 05/29/2022
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Provider Practice Location Address
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Address Line | 7321 S LINDBERGH BLVD STE 320
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City | SAINT LOUIS
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State | MO
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Zip | 63125-4500
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Country | US
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Telephone | 314-222-7344
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 VANDALIA ST STE 9
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4859
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Country | US
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Telephone | 618-301-9845
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | OTIS GAMBLE
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Credential |
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Telephone | 618-301-9845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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