Provider Demographics
NPI:1326311861
Name:MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PC - PENNSYLVANIA
Other - Org Name:MEDEXPRESS URGENT CARE - GREENSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-349-6740
Mailing Address - Street 1:423 FORTRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1351
Mailing Address - Country:US
Mailing Address - Phone:304-225-2500
Mailing Address - Fax:304-985-6350
Practice Address - Street 1:5126 ROUTE 30
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7835
Practice Address - Country:US
Practice Address - Phone:724-836-3028
Practice Address - Fax:724-836-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6301800039Medicare NSC
PA157885Medicare PIN