Provider Demographics
NPI:1497271589
Name:FASTPASS UCDFW, PLLC
Entity Type:Organization
Organization Name:FASTPASS UCDFW, PLLC
Other - Org Name:CODE 3 URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE MOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-320-9820
Mailing Address - Street 1:5300 TOWN AND COUNTRY BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6913
Mailing Address - Country:US
Mailing Address - Phone:469-208-5297
Mailing Address - Fax:214-260-0707
Practice Address - Street 1:2333 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE NV202A
Practice Address - City:DFW AIRPORT
Practice Address - State:TX
Practice Address - Zip Code:75261
Practice Address - Country:US
Practice Address - Phone:214-997-1950
Practice Address - Fax:214-242-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy