Provider Demographics
NPI:1821372624
Name:MEDEXPRESS URGENT CARE, PC - VIRGINIA
Entity Type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PC - VIRGINIA
Other - Org Name:MEDEXPRESS URGENT CARE - BLUEFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PAYOR CONTRACTING
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:G
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 1:4003 COLLEGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2043
Practice Address - Country:US
Practice Address - Phone:276-322-2085
Practice Address - Fax:276-322-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2013-05-20
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
VA1215219878Medicaid
WV3810022525Medicaid
VAA489Medicare PIN
WV3810022525Medicaid