MEDICARE: MEDEXPRESS URGENT CARE, PC - MICHIGAN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457704975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEXPRESS URGENT CARE, PC - MICHIGAN

Provider Business Mailing Address
First Line	:	1001 CONSOL ENERGY DR
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-6506
Country	:	US
Telephone Number	:	304-225-2500
Fax Number	:	724-743-1133

Provider Business Practice Location Address
First Line	:	1803 M 139
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-6103
Country	:	US
Telephone Number	:	269-934-8550
Fax Number	:	269-934-8660

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

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	12/27/2016

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