Provider Demographics
NPI:1972826824
Name:FASTRAC MEDICAL CENTER
Entity Type:Organization
Organization Name:FASTRAC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RORY
Authorized Official - Middle Name:LADELL
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:504-259-1834
Mailing Address - Street 1:213 RUELLE DU CHENE DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3109
Mailing Address - Country:US
Mailing Address - Phone:601-668-9843
Mailing Address - Fax:
Practice Address - Street 1:213 RUELLE DU CHENE DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3109
Practice Address - Country:US
Practice Address - Phone:601-668-9843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05926261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care