Provider Demographics
NPI:1003372756
Name:EXPRESS CARE GROUP, LLC
Entity Type:Organization
Organization Name:EXPRESS CARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-326-6423
Mailing Address - Street 1:204 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-3612
Mailing Address - Country:US
Mailing Address - Phone:580-326-6423
Mailing Address - Fax:580-317-9233
Practice Address - Street 1:204 N 12TH ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3612
Practice Address - Country:US
Practice Address - Phone:580-326-6423
Practice Address - Fax:580-317-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty