Provider Demographics
NPI:1194041871
Name:FAST LANE OF ZACHARY LLC
Entity Type:Organization
Organization Name:FAST LANE OF ZACHARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-570-2618
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:STE H/I
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-0427
Mailing Address - Country:US
Mailing Address - Phone:225-570-2618
Mailing Address - Fax:225-570-8539
Practice Address - Street 1:19900 OLD SCENIC HWY
Practice Address - Street 2:STE H/I
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7367
Practice Address - Country:US
Practice Address - Phone:225-570-2618
Practice Address - Fax:225-570-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care