Provider Demographics
NPI:1710227293
Name:EXPRESS MED OF KING OF PRUSSIA LLC
Entity Type:Organization
Organization Name:EXPRESS MED OF KING OF PRUSSIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-483-8447
Mailing Address - Street 1:322 EDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4716
Mailing Address - Country:US
Mailing Address - Phone:610-401-8368
Mailing Address - Fax:
Practice Address - Street 1:107 TOWN CENTER RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2330
Practice Address - Country:US
Practice Address - Phone:610-401-8368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care