MEDICARE: FAST TRACK URGENT CARE - LEMON CREEK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1215703061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST TRACK URGENT CARE - LEMON CREEK

Provider Business Mailing Address
First Line	:	PO BOX 33173
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78265-3173
Country	:	US
Telephone Number	:	210-890-8840
Fax Number	:	210-787-2030

Provider Business Practice Location Address
First Line	:	29252 INTERSTATE 10 W STE 106
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-3357
Country	:	US
Telephone Number	:	210-906-8478
Fax Number	:	210-787-2030

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	KELLY LANE DENNIS
Credential	:
Telephone Number	:	210-890-8840

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	01/16/2026

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