Provider Demographics
NPI:1821378571
Name:SENIOR XPRESS CARE LLC
Entity Type:Organization
Organization Name:SENIOR XPRESS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:941-921-7788
Mailing Address - Street 1:5310 CLARK RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3229
Mailing Address - Country:US
Mailing Address - Phone:941-921-7788
Mailing Address - Fax:941-921-3399
Practice Address - Street 1:5310 CLARK RD STE 206
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3229
Practice Address - Country:US
Practice Address - Phone:941-921-7788
Practice Address - Fax:941-921-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102629363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG69954Medicare UPIN