MEDICARE: MEDEXPRESS URGENT CARE, LLC - ADAMS TOWNSHIP

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	207P00000X	Emergency Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1235227422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEXPRESS URGENT CARE, LLC - ADAMS TOWNSHIP

Provider Business Mailing Address
First Line	:	PO BOX 719
Second Line	:
City	:	DELLSLOW
State	:	WV
Zip	:	26531-0719
Country	:	US
Telephone Number	:	304-985-3627
Fax Number	:	304-985-3630

Provider Business Practice Location Address
First Line	:	6998 CRIDER RD
Second Line	:	SUITE 100
City	:	MARS
State	:	PA
Zip	:	16046-2390
Country	:	US
Telephone Number	:	724-778-3627
Fax Number	:	724-778-3630

Authorized Official
Title or Position	:	VP OF PAYOR CONTRACTING
Name	:	TIMOTHY BUGIN
Credential	:
Telephone Number	:	304-225-2500

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	11/08/2010

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