Provider Demographics
NPI:1568087526
Name:FAST TRACK URGENT CARE LLC
Entity Type:Organization
Organization Name:FAST TRACK URGENT CARE LLC
Other - Org Name:FAST TRACK URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NAEEM
Authorized Official - Middle Name:Z
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-720-4343
Mailing Address - Street 1:2400 NORTH BLVD W STE 1
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8980
Mailing Address - Country:US
Mailing Address - Phone:252-469-3352
Mailing Address - Fax:863-419-0025
Practice Address - Street 1:2400 NORTH BLVD W STE 1
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8980
Practice Address - Country:US
Practice Address - Phone:402-720-4343
Practice Address - Fax:863-419-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100924200Medicaid