Provider Demographics
NPI:1013375237
Name:MEDEXPRESS RED BAY LLC
Entity Type:Organization
Organization Name:MEDEXPRESS RED BAY LLC
Other - Org Name:MEDEXPRESS RED BAY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-265-9641
Mailing Address - Street 1:221 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-3858
Mailing Address - Country:US
Mailing Address - Phone:256-356-8907
Mailing Address - Fax:256-356-8903
Practice Address - Street 1:221 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582-3858
Practice Address - Country:US
Practice Address - Phone:256-356-8907
Practice Address - Fax:256-356-8903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HH HEALTH SYSTEM - SHOALS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALB3004261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL161453Medicaid
AL013460Medicare Oscar/Certification