Provider Demographics
NPI:1497948517
Name:FASTRACK MEDICAL SUPPLIES,INC.
Entity Type:Organization
Organization Name:FASTRACK MEDICAL SUPPLIES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:BALBON
Authorized Official - Last Name:RARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-982-9440
Mailing Address - Street 1:7301 N LINCOLN AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1709
Mailing Address - Country:US
Mailing Address - Phone:847-982-9440
Mailing Address - Fax:847-982-9442
Practice Address - Street 1:7301 N LINCOLN AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1735
Practice Address - Country:US
Practice Address - Phone:847-982-9440
Practice Address - Fax:847-982-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid