Provider Demographics
NPI:1811432115
Name:FASTPASS UCM, PLLC
Entity type:Organization
Organization Name:FASTPASS UCM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE MOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-275-9234
Mailing Address - Street 1:5300 TOWN AND COUNTRY BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6894
Mailing Address - Country:US
Mailing Address - Phone:469-320-9820
Mailing Address - Fax:
Practice Address - Street 1:1080 E CARTWRIGHT RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:214-275-9234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FASTPASS UCC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty