NPIMap

Organization Active NPI

Medexpress Urgent Care Minnesota P.C.

Doing business as MedExpress Urgent Care - Andover, Bunker Lake Blvd NW

  • Urgent Care Clinic/Center
  • Andover, MN
National Provider Identifier
1669904785
Registry record updated Jun 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
MEDEXPRESS URGENT CARE MINNESOTA P.C.
Doing business as
MedExpress Urgent Care - Andover, Bunker Lake Blvd NW
Practice address
2134 Bunker Lake Blvd NW
Suite 100
Andover, MN 55304-3910
Phone
(763) 754-4396
Fax
(763) 754-9198
NPI assigned
Mar 29, 2017
Last updated
Jun 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2017

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

Authorized official

Name
Mr. Brett Gall
Title
Director Payor Contracting
Phone
(304) 225-2500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary
Emergency Medicine Physician 207P00000X

Addresses

Primary practice location

2134 Bunker Lake Blvd NW
Suite 100
Andover, MN 55304-3910

Mailing address

1001 Consol Energy Dr
Canonsburg, PA 15317-6506
Phone (304) 225-2500

Other identifiers 1

IdentifierTypeStateIssuer
1588025332MedicaidMN

Other names 1

  • MedExpress Urgent Care - Andover, Bunker Lake Blvd NW Doing business as

National Provider Directory

National Provider Directory

Locations

2134 Bunker Lake Blvd NW
#100
Andover, MN 55304
Phone (763) 754-4396

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496275200000",
    "number": "1669904785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CONSOL ENERGY DR",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153176506",
            "telephone_number": "304-225-2500",
            "fax_number": "724-743-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2134 BUNKER LAKE BLVD NW",
            "address_2": "SUITE 100",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043910",
            "telephone_number": "763-754-4396",
            "fax_number": "763-754-9198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDEXPRESS URGENT CARE MINNESOTA P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2017-06-01",
        "status": "A",
        "authorized_official_last_name": "GALL",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "DIRECTOR PAYOR CONTRACTING",
        "authorized_official_telephone_number": "304-225-2500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588025332",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedExpress Urgent Care - Andover, Bunker Lake Blvd NW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Andover, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2017; 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.