Provider Demographics
NPI:1003679184
Name:FAST TRACK MEDICAL LLC
Entity Type:Organization
Organization Name:FAST TRACK MEDICAL LLC
Other - Org Name:LONG HEALTHCARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENITA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:BARRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-436-9300
Mailing Address - Street 1:916 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1400
Mailing Address - Country:US
Mailing Address - Phone:314-436-9300
Mailing Address - Fax:
Practice Address - Street 1:916 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-1400
Practice Address - Country:US
Practice Address - Phone:314-436-9300
Practice Address - Fax:833-367-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care