Provider Demographics
NPI:1922614965
Name:CHILDREN EXPRESS CARE CLINIC LLC
Entity Type:Organization
Organization Name:CHILDREN EXPRESS CARE CLINIC LLC
Other - Org Name:CHILDREN EXPRESS CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-362-0293
Mailing Address - Street 1:5435 EMERSON WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1470
Mailing Address - Country:US
Mailing Address - Phone:317-362-0293
Mailing Address - Fax:317-672-4145
Practice Address - Street 1:5435 EMERSON WAY STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1470
Practice Address - Country:US
Practice Address - Phone:317-362-0293
Practice Address - Fax:317-672-4145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-16
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty