Provider Demographics
NPI:1164805545
Name:MEDCARE EXPRESS - NORTH CHARLESTON LLC
Entity type:Organization
Organization Name:MEDCARE EXPRESS - NORTH CHARLESTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-656-2750
Mailing Address - Street 1:216 CENTERVIEW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3226
Mailing Address - Country:US
Mailing Address - Phone:615-656-2750
Mailing Address - Fax:616-656-2745
Practice Address - Street 1:8740 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9211
Practice Address - Country:US
Practice Address - Phone:873-377-2406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDCARE EXPRESS - NORTH CHARLESTON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5210Medicaid
SC8736Medicare UPIN