MEDICARE: MEN'S HEALTH EXPRESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1093691727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEN'S HEALTH EXPRESS LLC

Provider Business Mailing Address
First Line	:	1868 DAYTON GERMANTOWN PIKE
Second Line	:
City	:	GERMANTOWN
State	:	OH
Zip	:	45327-1100
Country	:	US
Telephone Number	:	937-895-0081
Fax Number	:	937-895-0066

Provider Business Practice Location Address
First Line	:	1868 DAYTON GERMANTOWN PIKE
Second Line	:
City	:	GERMANTOWN
State	:	OH
Zip	:	45327-1100
Country	:	US
Telephone Number	:	937-895-0081
Fax Number	:	937-895-0066

Authorized Official
Title or Position	:	OWNER
Name	:	SHANNON WELLS
Credential	:	FNP
Telephone Number	:	937-895-0081

Provider Enumeration Date	:	08/15/2025
Last Update Date	:	08/15/2025

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