MEDICARE: MEDEXPRESS PRIMARY CARE MINNESOTA, P.C.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1841716883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEXPRESS PRIMARY CARE MINNESOTA, P.C.

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	:	2 OPTUM CIR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2956
Country	:	US
Telephone Number	:	952-205-2170
Fax Number	:	952-205-3731

Authorized Official
Title or Position	:	CONTRACT MANAGER
Name	:	JOY KIMBALL
Credential	:
Telephone Number	:	304-225-2500

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	11/22/2024

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