MEDICARE: MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA

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	:	1801175492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA

Provider Business Mailing Address
First Line	:	423 FORTRESS BLVD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-1351
Country	:	US
Telephone Number	:	304-225-2500
Fax Number	:	304-985-6350

Provider Business Practice Location Address
First Line	:	205 APPLEGATE ROAD
Second Line	:	SUITE 101
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6502
Country	:	US
Telephone Number	:	570-424-3278
Fax Number	:	570-424-5085

Authorized Official
Title or Position	:	CENTER MANAGER
Name	:	JOY KIMBALL
Credential	:
Telephone Number	:	763-349-6740

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	05/01/2024

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