Organization Name: | EXPRESS CARE CLINIC, LLC |
NPI Number: | 1114256799 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARGARET ANN BLACKBURN (OWNER) |
Mailing Address: | 1455 Robert C Byrd Dr Crab Orchard |
State: | WV US |
Postal Code: | 258279441 |
Phone Number: | 3042555533 |
Fax Number: | 3049295533 |
NPI Enumeration Date: | 12/10/2009 |
NPI Last Update Date: | 12/10/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 48923 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |