Provider Demographics
NPI:1811141005
Name:MEDEXPRESS URGENT CARE, PC - MOON TOWNSHIP
Entity type:Organization
Organization Name:MEDEXPRESS URGENT CARE, PC - MOON TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PAYOR CONTRACTING & REIMBURSEMEN
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-225-2500
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:DELLSLOW
Mailing Address - State:WV
Mailing Address - Zip Code:26531-0719
Mailing Address - Country:US
Mailing Address - Phone:304-985-3627
Mailing Address - Fax:304-985-3630
Practice Address - Street 1:8702 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4209
Practice Address - Country:US
Practice Address - Phone:412-299-3627
Practice Address - Fax:304-299-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
157881Medicare PIN
6301790001Medicare NSC