Provider Demographics
NPI:1114459237
Name:MEDEXPRESS URGENT CARE MINNESOTA P.C.
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE MINNESOTA P.C.
Other - Org Name:MEDEXPRESS URGENT CARE - COLUMBIA HEIGHTS, CENTRAL AVE NE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-225-2500
Mailing Address - Street 1:1001 CONSOL ENERGY DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-6506
Mailing Address - Country:US
Mailing Address - Phone:304-225-2500
Mailing Address - Fax:724-743-1133
Practice Address - Street 1:4880 CENTRAL AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLTOP
Practice Address - State:MN
Practice Address - Zip Code:55421-1950
Practice Address - Country:US
Practice Address - Phone:763-571-4536
Practice Address - Fax:763-571-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1588025332Medicaid