MEDICARE: EXPRESS MEDICAL 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	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1144185885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS MEDICAL LLC

Provider Business Mailing Address
First Line	:	11 S WHITE ST STE 104
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-4018
Country	:	US
Telephone Number	:	877-363-3772
Fax Number	:	762-722-8386

Provider Business Practice Location Address
First Line	:	11 S WHITE ST
Second Line	:	SUITE 104
City	:	FRANKFORT
State	:	IL
Zip	:	60423-4009
Country	:	US
Telephone Number	:	877-363-3772
Fax Number	:	762-722-8386

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	COURTNEY B CANTRELL
Credential	:
Telephone Number	:	423-413-3832

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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