Basic Information
| Provider Information | |||||||||
| NPI: | 1407518160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDEXPRESS URGENT CARE, PC - TENNESSEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 CONSOL ENERGY DR | ||||||||
| Address2: | |||||||||
| City: | CANONSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153176506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042252500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 TENNESSEE WALTZ PKWY | ||||||||
| Address2: | |||||||||
| City: | ASHLAND CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370151234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157926220 | ||||||||
| FaxNumber: | 6157922603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2021 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | GALL | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR PAYOR CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 3042252500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.