Provider Demographics
NPI:1235441098
Name:MEDXPRESS
Entity Type:Organization
Organization Name:MEDXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:PAMBID
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-771-0354
Mailing Address - Street 1:PO BOX 2645
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0264
Mailing Address - Country:US
Mailing Address - Phone:707-771-0354
Mailing Address - Fax:707-422-1784
Practice Address - Street 1:1642 N TEXAS ST
Practice Address - Street 2:SUITE D
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3889
Practice Address - Country:US
Practice Address - Phone:707-771-0354
Practice Address - Fax:707-422-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA7790877343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)