Provider Demographics
NPI:1821523382
Name:FASTPASS UCC, PLLC
Entity Type:Organization
Organization Name:FASTPASS UCC, PLLC
Other - Org Name:CODE 3 URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL; CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE MOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-320-9820
Mailing Address - Street 1:5300 TOWN AND COUNTRY BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6913
Mailing Address - Country:US
Mailing Address - Phone:469-208-5297
Mailing Address - Fax:214-260-0707
Practice Address - Street 1:12600 ROLATER RD STE 120
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5188
Practice Address - Country:US
Practice Address - Phone:214-383-7543
Practice Address - Fax:214-383-7544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FASTPASS UCC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-21
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX511138OtherMEDICARE