NPIMap

Organization Active NPI

Medexpress Primary Care Minnesota, P.C.

  • General Practice Physician
  • Duluth, MN
National Provider Identifier
1013561893
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MEDEXPRESS PRIMARY CARE MINNESOTA, P.C.
Practice address
4316 Rice Lake Rd
Duluth, MN 55811-4012
Phone
(952) 205-1252
NPI assigned
Jul 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joy Kimball
Title
Contract Manager
Phone
(763) 349-6740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

4316 Rice Lake Rd
Duluth, MN 55811-4012

Mailing address

423 Fortress Blvd
Morgantown, WV 26508-1351
Phone (304) 225-2500

Other names 1

  • The Well - Duluth Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medexpress Primary Care Minnesota PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4316 Rice Lake Rd
Duluth, MN 55811
Phone (952) 205-1252

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1013561893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 FORTRESS BLVD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265081351",
            "telephone_number": "304-225-2500",
            "fax_number": "304-985-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4316 RICE LAKE RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558114012",
            "telephone_number": "952-205-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDEXPRESS PRIMARY CARE MINNESOTA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-30",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "JOY",
        "authorized_official_title_or_position": "CONTRACT MANAGER",
        "authorized_official_telephone_number": "763-349-6740"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Well - Duluth",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Well - Duluth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.