Healthcare Provider Details

I. General information

NPI: 1093065633
Provider Name (Legal Business Name): FAST360 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 49TH ST N STE 100
CLEARWATER FL
33762
US

IV. Provider business mailing address

10200 49TH ST N STE 100
CLEARWATER FL
33762-5030
US

V. Phone/Fax

Practice location:
  • Phone: 866-535-0905
  • Fax: 727-535-0955
Mailing address:
  • Phone: 866-535-0905
  • Fax: 727-535-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: CINDY LIU
Title or Position: LICENSING AND COMPLIANCE SPECIALIST
Credential:
Phone: 301-547-3683