MEDICARE: EXPRESS MED, 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	364SF0001X	Family Health Clinical Nurse Specialist	APN12850	TN

General Provider Information

NPI Number	:	1790976447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS MED, LLC

Provider Business Mailing Address
First Line	:	1276 1ST AVE
Second Line	:
City	:	LAWRENCEBURG
State	:	TN
Zip	:	38464-2762
Country	:	US
Telephone Number	:	931-766-7056
Fax Number	:	931-766-7057

Provider Business Practice Location Address
First Line	:	1276 1ST AVE
Second Line	:
City	:	LAWRENCEBURG
State	:	TN
Zip	:	38464-2762
Country	:	US
Telephone Number	:	931-766-7056
Fax Number	:	931-766-7057

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	SHEILA K MCLAIN
Credential	:
Telephone Number	:	931-766-7056

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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