Provider Demographics
NPI:1972132082
Name:EXPRESS-MED, LLC
Entity Type:Organization
Organization Name:EXPRESS-MED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURELL MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-850-3494
Mailing Address - Street 1:3201 W HILLSBOROUGH AVE STE 152772
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5940
Mailing Address - Country:US
Mailing Address - Phone:813-850-3494
Mailing Address - Fax:
Practice Address - Street 1:12916 PARKINGTON DR
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-3914
Practice Address - Country:US
Practice Address - Phone:813-850-3494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)