Provider Demographics
NPI:1447442454
Name:NEW RIVER MEDEXPRESS, PLLC
Entity type:Organization
Organization Name:NEW RIVER MEDEXPRESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-355-5110
Mailing Address - Street 1:305 S ANDREWS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1859
Mailing Address - Country:US
Mailing Address - Phone:954-355-5110
Mailing Address - Fax:
Practice Address - Street 1:305 S ANDREWS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1859
Practice Address - Country:US
Practice Address - Phone:954-355-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty