Provider Demographics
NPI:1639829286
Name:BROCK EXPRESS MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:BROCK EXPRESS MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:443-449-1269
Mailing Address - Street 1:2326 CALVERTON HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-4809
Mailing Address - Country:US
Mailing Address - Phone:443-449-1269
Mailing Address - Fax:
Practice Address - Street 1:2326 CALVERTON HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-4809
Practice Address - Country:US
Practice Address - Phone:443-449-1269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service