MEDICARE: EXPRESS MEDICAL CARE INC

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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	822669	OTHER	VA	OPTIMUM CHOICE
2	070018	OTHER	VA	ANTHEM
3	47148	OTHER	VA	SENTARA

General Provider Information

NPI Number	:	1447219241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS MEDICAL CARE INC

Provider Business Mailing Address
First Line	:	1543 AMBERLEY FOREST ROAD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453
Country	:	US
Telephone Number	:	757-471-7700
Fax Number	:	757-471-9541

Provider Business Practice Location Address
First Line	:	1543 AMBERLEY FOREST ROAD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453
Country	:	US
Telephone Number	:	757-471-7700
Fax Number	:	757-471-9541

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WAYNE MICHAEL MCDERMOTT
Credential	:	MD
Telephone Number	:	757-471-7700

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	11/09/2007

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