Provider Demographics
NPI:1043663115
Name:EXPRESS CARE, LLC
Entity Type:Organization
Organization Name:EXPRESS CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:903-223-5931
Mailing Address - Street 1:5483 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4608
Mailing Address - Country:US
Mailing Address - Phone:903-223-5931
Mailing Address - Fax:903-223-5930
Practice Address - Street 1:5483 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4608
Practice Address - Country:US
Practice Address - Phone:903-223-5931
Practice Address - Fax:903-223-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0147207Q00000X
TX613479363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR80153279OtherRAILROAD MEDICARE
TXNNP01259Medicaid
ARF94382Medicare UPIN
AR5U125Medicare PIN
AR80153279OtherRAILROAD MEDICARE
ARS67010Medicare UPIN
AR5U125B438Medicare PIN