Provider Demographics
NPI:1780323758
Name:EXPRESS CLINICAL SERVICES
Entity type:Organization
Organization Name:EXPRESS CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-301-9845
Mailing Address - Street 1:2105 VANDALIA ST STE 9
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4859
Mailing Address - Country:US
Mailing Address - Phone:618-301-9845
Mailing Address - Fax:
Practice Address - Street 1:7321 S LINDBERGH BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4500
Practice Address - Country:US
Practice Address - Phone:314-222-7344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-29
Last Update Date:2022-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty