Provider Demographics
NPI:1134492788
Name:MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA
Other - Org Name:MEDEXPRESS URGENT CARE - UPPER ST. CLAIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUGIN
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 1:2600 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 150
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-2524
Practice Address - Country:US
Practice Address - Phone:412-854-3627
Practice Address - Fax:412-854-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6301800042Medicare NSC
PA157885Medicare PIN