Provider Demographics
NPI:1336189158
Name:EXPRESS HEALTH CLINIC CORPORATION
Entity Type:Organization
Organization Name:EXPRESS HEALTH CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:865-475-9969
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:127 W. MEETING STREET
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-0385
Mailing Address - Country:US
Mailing Address - Phone:865-475-9969
Mailing Address - Fax:865-475-9901
Practice Address - Street 1:153 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2517
Practice Address - Country:US
Practice Address - Phone:865-475-9969
Practice Address - Fax:865-475-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1336189158OtherNPI
TN30971811Medicare UPIN