Provider Demographics
NPI:1033340716
Name:EXPRESSCARE PEDIATRICS, PC
Entity type:Organization
Organization Name:EXPRESSCARE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX-FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-551-2422
Mailing Address - Street 1:2153 E MAIN ST
Mailing Address - Street 2:STE C14-321
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8724
Mailing Address - Country:US
Mailing Address - Phone:864-551-2422
Mailing Address - Fax:864-551-2424
Practice Address - Street 1:274 COMMONWEALTH DR
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4869
Practice Address - Country:US
Practice Address - Phone:864-551-2422
Practice Address - Fax:864-551-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC274517Medicaid
SCG30930Medicare UPIN