Provider Demographics
NPI:1528581063
Name:MEDEXPRESS URGENT CARE, PC - VIRGINIA
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PC - VIRGINIA
Other - Org Name:MEDEXPRESS URGENT CARE - MARION, N MAIN ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PAYOR CONTRACTING
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALL
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 1:1583 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4317
Practice Address - Country:US
Practice Address - Phone:276-782-1173
Practice Address - Fax:276-782-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty