Provider Demographics
NPI:1346411600
Name:MEDEXPRESS URGENT CARE, PLLC - BECKLEY
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PLLC - BECKLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-225-2500
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:DELLSLOW
Mailing Address - State:WV
Mailing Address - Zip Code:26531-0719
Mailing Address - Country:US
Mailing Address - Phone:304-985-3627
Mailing Address - Fax:304-985-3630
Practice Address - Street 1:1709 HARPER ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3311
Practice Address - Country:US
Practice Address - Phone:304-256-3027
Practice Address - Fax:304-256-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2012-02-13
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
WV51D1083386OtherCLIA
WV01025OtherSTATE LICENSE
WV3810011911Medicaid
9375781Medicare PIN
6269810001Medicare NSC