Provider Demographics
NPI:1568920387
Name:FASTMED HOLDINGS, PLLC
Entity Type:Organization
Organization Name:FASTMED HOLDINGS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NAT. CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:STAYMATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-500-2285
Mailing Address - Street 1:935 SHOTWELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5598
Mailing Address - Country:US
Mailing Address - Phone:480-500-2285
Mailing Address - Fax:919-882-9575
Practice Address - Street 1:160 HENDERSONVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2680
Practice Address - Country:US
Practice Address - Phone:828-210-2835
Practice Address - Fax:828-210-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty