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General NPI Number Information
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NPI Number | 1801102215
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Entity Type | Organization
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Legal Business Name | EXPRESS MEDICAL CARE, LLC
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Dates
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Enumeration Date | 08/23/2010
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 5031 N ILLINOIS ST
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-3453
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Country | US
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Telephone | 618-212-6800
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Fax | 618-212-6820
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Provider Business Mailing Address
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Address Line | 5031 N ILLINOIS ST
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-3453
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Country | US
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Telephone | 618-212-6800
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Fax | 618-212-6820
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | KEVIN M. HAZLETT
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Credential |
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Telephone | 618-236-6000
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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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