Provider Demographics
NPI:1154636074
Name:EXPRESS MEDICAL STAFFING, INC.
Entity type:Organization
Organization Name:EXPRESS MEDICAL STAFFING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-649-3200
Mailing Address - Street 1:8475 HIGHWAY 165
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:LA
Mailing Address - Zip Code:71418-4335
Mailing Address - Country:US
Mailing Address - Phone:318-649-3200
Mailing Address - Fax:
Practice Address - Street 1:228 RISER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:LA
Practice Address - Zip Code:71418-4335
Practice Address - Country:US
Practice Address - Phone:318-649-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8489251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1639367113Medicaid
LA1285949743Medicaid
LA1548458029Medicaid
LA199299216Medicaid