Provider Demographics
NPI:1649596321
Name:FAST LANE OF CENTRAL LLC
Entity Type:Organization
Organization Name:FAST LANE OF CENTRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-278-2302
Mailing Address - Street 1:11421 SULLIVAN RD
Mailing Address - Street 2:BLDG B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11421 SULLIVAN RD
Practice Address - Street 2:BLDG B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818
Practice Address - Country:US
Practice Address - Phone:225-278-2302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care