Provider Demographics
NPI:1194198382
Name:SYNERGIC HEALTHCARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:SYNERGIC HEALTHCARE SOLUTIONS LLC
Other - Org Name:FAST TRACK URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARON
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIECIDUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-925-1903
Mailing Address - Street 1:PO BOX 15490
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-5490
Mailing Address - Country:US
Mailing Address - Phone:318-424-4008
Mailing Address - Fax:855-230-1466
Practice Address - Street 1:5504 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-1900
Practice Address - Country:US
Practice Address - Phone:813-925-1903
Practice Address - Fax:813-749-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7646Medicare PIN