Basic Information
| Provider Information | |||||||||
| NPI: | 1760505770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXPRESS CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 SOUTH CRYSTAL | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BUTTE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597011506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064963600 | ||||||||
| FaxNumber: | 4064963609 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 SOUTH CRYSTAL | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BUTTE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597011506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064963600 | ||||||||
| FaxNumber: | 4064963609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | NYBERG | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4064963600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROCKY MOUNTAIN MEDICAL SERVICE, PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.