Healthcare Provider Details

I. General information

NPI: 1861223109
Provider Name (Legal Business Name): FAST TRACK COMMUNICATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 BROOKSTONE RD
HEPHZIBAH GA
30815-7902
US

IV. Provider business mailing address

PO BOX 231
GRACEWOOD GA
30812-0231
US

V. Phone/Fax

Practice location:
  • Phone: 316-727-4992
  • Fax:
Mailing address:
  • Phone: 316-727-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MRS. PORSCHE HARRIS
Title or Position: OWNER
Credential:
Phone: 316-727-4992