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General NPI Number Information
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NPI Number | 1831252121
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Entity Type | Organization
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Legal Business Name | THE EXPRESS CLINIC, LLC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 2525 PINE LAKE ROAD PRACTICE LOCATION 68512 PO 23048 68542
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City | LINCOLN
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State | NE
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Zip | 68542
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Country | US
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Telephone | 402-420-2094
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Fax | 402-420-2095
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Provider Business Mailing Address
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Address Line | PO 23048
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City | LINCOLN
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State | NE
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Zip | 68542
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Country | US
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Telephone | 402-420-2094
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Fax | 402-420-2095
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MRS. BETTE GRACE TUCKER
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Credential | NP
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Telephone | 402-423-4739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 219844341
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License Number State | NE
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