MEDICARE: FAST TRACK MEDICAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1568770626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST TRACK MEDICAL LLC

Provider Business Mailing Address
First Line	:	2686 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-1438
Country	:	US
Telephone Number	:	314-921-7300
Fax Number	:	314-395-2123

Provider Business Practice Location Address
First Line	:	5701 CHIPPEWA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1544
Country	:	US
Telephone Number	:	314-921-7300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER LONG
Credential	:
Telephone Number	:	314-921-7300

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	04/11/2024

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Directions to “FAST TRACK MEDICAL LLC ” Practice Location

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