Provider Demographics
NPI:1225496821
Name:FAST TRACK PEDIATRICS
Entity Type:Organization
Organization Name:FAST TRACK PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUNLAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-433-2633
Mailing Address - Street 1:1133 SE 18TH PL STE 1
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5404
Mailing Address - Country:US
Mailing Address - Phone:352-433-2633
Mailing Address - Fax:352-433-2644
Practice Address - Street 1:1133 SE 18TH PL STE 1
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5404
Practice Address - Country:US
Practice Address - Phone:352-433-2633
Practice Address - Fax:352-433-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101959261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000044901Medicaid
FL1326000456OtherPERSONAL NPI