Provider Demographics
NPI:1831473057
Name:EXPRESS CARE & FAMILY PRACTICE CENTER, PA
Entity Type:Organization
Organization Name:EXPRESS CARE & FAMILY PRACTICE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:REID
Authorized Official - Last Name:BEAMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:252-308-0686
Mailing Address - Street 1:93 NC HIGHWAY 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6351
Mailing Address - Country:US
Mailing Address - Phone:252-308-0686
Mailing Address - Fax:252-308-0729
Practice Address - Street 1:93 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6351
Practice Address - Country:US
Practice Address - Phone:252-308-0686
Practice Address - Fax:252-308-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101911261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty