Provider Demographics
NPI:1477759348
Name:THE EXPRESS CLINIC, LLC
Entity Type:Organization
Organization Name:THE EXPRESS CLINIC, LLC
Other - Org Name:EXPRESS CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-440-1312
Mailing Address - Street 1:PO BOX 23048
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68542
Mailing Address - Country:US
Mailing Address - Phone:402-420-2094
Mailing Address - Fax:402-420-2095
Practice Address - Street 1:2525 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3632
Practice Address - Country:US
Practice Address - Phone:402-420-2094
Practice Address - Fax:402-420-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty