Organization
MEDEXPRESS URGENT CARE, PLLC - CHARLESTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY BUGIN (VP OF PAYOR CONTRACTING)
(304) 225-2500
Entity
Organization
Contact information
Practice address
5430 MACCORKLE AVE SE, CHARLESTON, WV 25304-2224
(304) 925-3627
(304) 925-1163
Mailing address
PO BOX 719, DELLSLOW, WV 26531-0719
(304) 985-3627
(304) 985-3630
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
01026
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810012430
—
WV
01
—
51D1089045
CLIA
WV
Enumeration date
05/29/2008
Last updated
02/13/2012
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