Provider Demographics
NPI:1609274786
Name:EXPRESSMED NEW ALBANY , LLC
Entity Type:Organization
Organization Name:EXPRESSMED NEW ALBANY , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-442-2431
Mailing Address - Street 1:2939 KENNY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2406
Mailing Address - Country:US
Mailing Address - Phone:440-274-5035
Mailing Address - Fax:440-716-8608
Practice Address - Street 1:153 W MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9225
Practice Address - Country:US
Practice Address - Phone:614-939-9110
Practice Address - Fax:614-939-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2338635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338635OtherSTATE REGISTRATION