Provider Demographics
NPI:1497913099
Name:EXPRESS CARE OF NEW ALBANY
Entity Type:Organization
Organization Name:EXPRESS CARE OF NEW ALBANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SWORDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-507-3330
Mailing Address - Street 1:210 HWY 30 W
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3112
Mailing Address - Country:US
Mailing Address - Phone:662-507-3330
Mailing Address - Fax:662-507-3333
Practice Address - Street 1:210 HWY 30 W
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3112
Practice Address - Country:US
Practice Address - Phone:662-507-3330
Practice Address - Fax:662-507-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR732974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty