Provider Demographics
NPI:1518972926
Name:HEALTH CARE EXPRESS CORPORATION
Entity Type:Organization
Organization Name:HEALTH CARE EXPRESS CORPORATION
Other - Org Name:HEALTH CARE EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:817-727-3182
Mailing Address - Street 1:4003 CALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3448
Mailing Address - Country:US
Mailing Address - Phone:817-727-3182
Mailing Address - Fax:682-518-5603
Practice Address - Street 1:5459 LA SIERRA DR STE 103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2348
Practice Address - Country:US
Practice Address - Phone:214-369-6102
Practice Address - Fax:214-369-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10276542251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1446114Medicaid
TX676512Medicare ID - Type UnspecifiedPROVIDER NUMBER