Provider Demographics
NPI:1821391491
Name:FASTMED URGENT CARE PC
Entity Type:Organization
Organization Name:FASTMED URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO, EASTERN REGION
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-550-0821
Mailing Address - Street 1:935 SHOTWELL RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5597
Mailing Address - Country:US
Mailing Address - Phone:919-550-0821
Mailing Address - Fax:919-550-0735
Practice Address - Street 1:178 HIGHWAY 105 EXT
Practice Address - Street 2:SUITE 101
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5254
Practice Address - Country:US
Practice Address - Phone:828-265-7146
Practice Address - Fax:828-265-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty