Provider Demographics
NPI:1801051354
Name:EXPRESS CARE CLINIC OF ONEONTA, P.C.
Entity type:Organization
Organization Name:EXPRESS CARE CLINIC OF ONEONTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:AVRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-878-1415
Mailing Address - Street 1:2040 2ND AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121
Mailing Address - Country:US
Mailing Address - Phone:256-878-1415
Mailing Address - Fax:
Practice Address - Street 1:2040 2ND AVENUE EAST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121
Practice Address - Country:US
Practice Address - Phone:256-878-1415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700352Medicare PIN