Provider Demographics
NPI:1891075016
Name:EXPRESS LANE URGENT CARE FREMONT, INC
Entity Type:Organization
Organization Name:EXPRESS LANE URGENT CARE FREMONT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-535-7500
Mailing Address - Street 1:1999 MOWRY AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1738
Mailing Address - Country:US
Mailing Address - Phone:510-791-6220
Mailing Address - Fax:510-791-2378
Practice Address - Street 1:1999 MOWRY AVE
Practice Address - Street 2:SUITE L
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1738
Practice Address - Country:US
Practice Address - Phone:510-791-6220
Practice Address - Fax:510-791-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care