# MEDEXPRESS URGENT CARE ILLINOIS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MedExpress Urgent Care - O'Fallon, W Highway 50
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700335080
- **Authorized official:** TIM BUGIN (VP PAYOR CONTRACTING)
- **Authorized official phone:** (304) 225-2500

## Contact information

- **Practice address:** 1711 W HIGHWAY 50, O FALLON, IL 62269-1681
- **Practice address phone:** (618) 628-1791
- **Practice address fax:** (618) 628-1795
- **Mailing address:** 1001 CONSOL ENERGY DR, CANONSBURG, PA 15317-6506
- **Mailing address phone:** (304) 225-2500
- **Mailing address fax:** (724) 743-1133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/27/2016
- **Last updated:** 03/24/2017