Healthcare Provider Details

I. General information

NPI: 1891604773
Provider Name (Legal Business Name): FASTTRACK MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 36TH ST
MUSKOGEE OK
74401-5079
US

IV. Provider business mailing address

201 S 36TH ST
MUSKOGEE OK
74401-5079
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-2701
  • Fax: 539-390-3009
Mailing address:
  • Phone: 918-600-2701
  • Fax: 539-390-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA W FORREST
Title or Position: CEO
Credential:
Phone: 918-805-4885