Provider Demographics
NPI:1225368350
Name:FASTCARE MEDICAL CLINIC OF EDMOND
Entity Type:Organization
Organization Name:FASTCARE MEDICAL CLINIC OF EDMOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-942-3737
Mailing Address - Street 1:PO BOX 14587
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-0587
Mailing Address - Country:US
Mailing Address - Phone:405-942-3737
Mailing Address - Fax:405-942-3873
Practice Address - Street 1:912 NW 150TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1829
Practice Address - Country:US
Practice Address - Phone:405-418-8660
Practice Address - Fax:405-418-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty