Provider Demographics
NPI:1902603764
Name:EXPRESS SERVICE ENTERPRISE GROUP LLC
Entity type:Organization
Organization Name:EXPRESS SERVICE ENTERPRISE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-239-9760
Mailing Address - Street 1:2844 MARLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5281
Mailing Address - Country:US
Mailing Address - Phone:608-239-9760
Mailing Address - Fax:
Practice Address - Street 1:2844 MARLEDGE ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5281
Practice Address - Country:US
Practice Address - Phone:608-239-9760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty