Provider Demographics
NPI:1235138280
Name:MEDEXPRESS URGENT CARE PLLC-MORGANTOWN
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE PLLC-MORGANTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-225-2500
Mailing Address - Street 1:1751 EARL L CORE ROAD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-225-2500
Mailing Address - Fax:304-985-6350
Practice Address - Street 1:215 DON KNOTTS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-6734
Practice Address - Country:US
Practice Address - Phone:304-291-3627
Practice Address - Fax:304-284-3630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDEXPRESS URGENT CARE PLLC-MORGANTOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-20
Last Update Date:2012-02-14
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
WV00043OtherSTATE LICENSE
WV3810002602Medicaid
WV51D0990987OtherCLIA
WV00043OtherSTATE LICENSE
WV3810002602Medicaid