Provider Demographics
NPI:1780890517
Name:EXPRESS CARE OF FULTON
Entity type:Organization
Organization Name:EXPRESS CARE OF FULTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CURBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-862-9040
Mailing Address - Street 1:202 INTERCHANGE DR
Mailing Address - Street 2:204 INTERCHANGE DRIVE
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-6011
Mailing Address - Country:US
Mailing Address - Phone:662-862-9040
Mailing Address - Fax:662-862-9091
Practice Address - Street 1:202 INTERCHANGE DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-6011
Practice Address - Country:US
Practice Address - Phone:662-862-9040
Practice Address - Fax:662-862-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015389Medicaid
MS09015389Medicaid