Provider Demographics
NPI:1104075522
Name:EXPRESS LANE URGENT CARE INC.
Entity type:Organization
Organization Name:EXPRESS LANE URGENT CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-664-1550
Mailing Address - Street 1:711 E HAWKEYE AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-7505
Mailing Address - Country:US
Mailing Address - Phone:209-664-1550
Mailing Address - Fax:209-664-1548
Practice Address - Street 1:711 E HAWKEYE AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-7505
Practice Address - Country:US
Practice Address - Phone:209-664-1550
Practice Address - Fax:209-664-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care