Provider Demographics
NPI:1669839494
Name:MEDEXPRESS URGENT CARE, PC - MICHIGAN
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PC - MICHIGAN
Other - Org Name:MEDEXPRESS URGENT CARE - HOLLAND, DOUGLAS AVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGIN
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 1:91 DOUGLAS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2183
Practice Address - Country:US
Practice Address - Phone:616-392-1852
Practice Address - Fax:616-393-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649694407Medicaid
MIMI7535Medicare PIN
MI1649694407Medicaid