Provider Demographics
NPI:1255845905
Name:EXPRESSMED, LLC
Entity Type:Organization
Organization Name:EXPRESSMED, LLC
Other - Org Name:NORTH COUNTRY MEDICAL AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-622-3670
Mailing Address - Street 1:700 LAKE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103
Mailing Address - Country:US
Mailing Address - Phone:603-782-8374
Mailing Address - Fax:603-782-5123
Practice Address - Street 1:152 COLBY STREET
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576
Practice Address - Country:US
Practice Address - Phone:603-331-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPRESSMED, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty