Provider Demographics
NPI:1205875630
Name:EXPRESS MEDICAL INCORPORATED
Entity type:Organization
Organization Name:EXPRESS MEDICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MIKUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-532-5154
Mailing Address - Street 1:312 W 9TH ST N
Mailing Address - Street 2:STE 2
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1270
Mailing Address - Country:US
Mailing Address - Phone:715-532-5154
Mailing Address - Fax:715-532-5941
Practice Address - Street 1:312 W 9TH ST N
Practice Address - Street 2:STE 2
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1270
Practice Address - Country:US
Practice Address - Phone:715-532-5154
Practice Address - Fax:715-532-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41665000Medicaid
WI0619220001Medicare NSC