Provider Demographics
NPI:1437653037
Name:EXPRESS MRO
Entity Type:Organization
Organization Name:EXPRESS MRO
Other - Org Name:PINE LEVEL FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-358-3777
Mailing Address - Street 1:2175 US HIGHWAY 31 N
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-2714
Mailing Address - Country:US
Mailing Address - Phone:334-568-2120
Mailing Address - Fax:334-568-2140
Practice Address - Street 1:2175 US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:DEATSVILLE
Practice Address - State:AL
Practice Address - Zip Code:36022-2714
Practice Address - Country:US
Practice Address - Phone:334-358-3777
Practice Address - Fax:334-358-0026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPRESS MRO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-20
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty