Provider Demographics
NPI: | 1427120310 |
---|---|
Name: | HEALTHCARE EXPRESS, LLP |
Entity type: | Organization |
Organization Name: | HEALTHCARE EXPRESS, LLP |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGING PARTNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TIMOTHY |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | REYNOLDS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 903-791-9355 |
Mailing Address - Street 1: | 3515 RICHMOND RD |
Mailing Address - Street 2: | |
Mailing Address - City: | TEXARKANA |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75503-0711 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 903-791-9355 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3515 RICHMOND RD |
Practice Address - Street 2: | |
Practice Address - City: | TEXARKANA |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75503-0711 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-791-9355 |
Practice Address - Fax: | 903-831-7258 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-15 |
Last Update Date: | 2020-11-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 207K00000X, 207N00000X, 207Q00000X, 208100000X, 2081P2900X, 2083X0100X, 2085R0202X, 261QM1200X, 261QM1300X, 261QP2000X, 261QX0100X | |
TX | PMC00462 | 208VP0014X |
TX | J7363 | 261QU0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
No | 261QM1200X | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | Group - Multi-Specialty |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 00219Y | Medicare PIN | |
TX | F93892 | Medicare UPIN | |
TX | 7350490001 | Medicare NSC |