Provider Demographics
NPI:1407227739
Name:MEDEXPRESS URGENT CARE ARKANSAS, P.A.
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE ARKANSAS, P.A.
Other - Org Name:MEDEXPRESS URGENT CARE - CABOT, W MAIN ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-225-2500
Mailing Address - Street 1:1001 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 1:1850 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2745
Practice Address - Country:US
Practice Address - Phone:501-605-0009
Practice Address - Fax:501-605-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2016-09-16
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
AR7153350011Medicare NSC
AR351032Medicare PIN