Provider Demographics
NPI:1295025179
Name:MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA
Other - Org Name:MEDEXPRESS URGENT CARE - HANOVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-225-2500
Mailing Address - Street 1:1001 CONSOL ENERGY DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-6506
Mailing Address - Country:US
Mailing Address - Phone:304-225-2500
Mailing Address - Fax:724-743-1133
Practice Address - Street 1:1139 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-4404
Practice Address - Country:US
Practice Address - Phone:717-633-3647
Practice Address - Fax:717-633-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2016-09-22
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
PA6301800018Medicare NSC
PA157885Medicare PIN