Provider Demographics
NPI:1912233172
Name:EXPRESSMED URGENT CARE CENTERS LLC
Entity type:Organization
Organization Name:EXPRESSMED URGENT CARE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUTHY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-798-9700
Mailing Address - Street 1:415 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1439
Mailing Address - Country:US
Mailing Address - Phone:801-798-9700
Mailing Address - Fax:801-798-3131
Practice Address - Street 1:415 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1439
Practice Address - Country:US
Practice Address - Phone:801-798-9700
Practice Address - Fax:801-798-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3737194405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty