Provider Demographics
NPI:1609332725
Name:FASTMED HEALTH NC, PLLC
Entity Type:Organization
Organization Name:FASTMED HEALTH NC, PLLC
Other - Org Name:FASTMED HEALTH NC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL SENIOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-520-2007
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:804-500-2285
Mailing Address - Fax:199-882-9575
Practice Address - Street 1:150 FRANCAM DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-4500
Practice Address - Country:US
Practice Address - Phone:910-487-1100
Practice Address - Fax:910-884-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty