Provider Demographics
NPI:1689931446
Name:MEDEXPRESS URGENT CARE, PC - TENNESSEE
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PC - TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PAYOR CONTRACTING
Authorized Official - Prefix:MR
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 1:370 SOUTHPOINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-8572
Mailing Address - Country:US
Mailing Address - Phone:304-225-2500
Mailing Address - Fax:724-743-1133
Practice Address - Street 1:2686 W STATE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1817
Practice Address - Country:US
Practice Address - Phone:423-844-0026
Practice Address - Fax:423-844-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2013-06-20
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
VA1689931446Medicaid
TN1527953Medicaid
TN6715900001Medicare NSC
TN103G709092Medicare PIN