Provider Demographics
NPI:1174668123
Name:XPRESS CARE
Entity Type:Organization
Organization Name:XPRESS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-866-0856
Mailing Address - Street 1:4471 CALDER AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6425
Mailing Address - Country:US
Mailing Address - Phone:409-866-0856
Mailing Address - Fax:409-866-0136
Practice Address - Street 1:4471 CALDER AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6425
Practice Address - Country:US
Practice Address - Phone:409-866-0856
Practice Address - Fax:409-866-0136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUMONT XPRESS CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG74386Medicare UPIN
TX00387WMedicare PIN