Provider Demographics
NPI:1295011757
Name:HEALTHCARE EXPRESS LLC
Entity Type:Organization
Organization Name:HEALTHCARE EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-206-3839
Mailing Address - Street 1:8507 LIBERTY RD
Mailing Address - Street 2:SUITE L1
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4833
Mailing Address - Country:US
Mailing Address - Phone:410-496-9105
Mailing Address - Fax:410-496-9109
Practice Address - Street 1:8507 LIBERTY RD
Practice Address - Street 2:SUITE L1
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4833
Practice Address - Country:US
Practice Address - Phone:410-496-9105
Practice Address - Fax:410-496-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1194772905OtherNPI - PERSONAL
MD13861800Medicaid
MDD0034730OtherMEDICAL LICENSE
MDM26728OtherSTATE CONTROLLED SUBSTANCE
MD10434322OtherCAQH
MD479931300Medicaid
MDD41430OtherLICENSE
MDM37304OtherSTATE CONTROLLED SUBSTANCE
MD1811964133OtherNPI PERSONAL
MDM37304OtherSTATE CONTROLLED SUBSTANCE
MD1811964133OtherNPI PERSONAL
MD1518532DFGMedicare Oscar/Certification
MDM26728OtherSTATE CONTROLLED SUBSTANCE
MD6549Medicare PIN
MDF89035Medicare UPIN