Healthcare Provider Details

I. General information

NPI: 1306535224
Provider Name (Legal Business Name): FAST TRACK URGENT CARE - LA GRANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W STATE HIGHWAY 71 STE B
LA GRANGE TX
78945-5058
US

IV. Provider business mailing address

PO BOX 33173
SAN ANTONIO TX
78265-3173
US

V. Phone/Fax

Practice location:
  • Phone: 979-206-2288
  • Fax: 979-206-2289
Mailing address:
  • Phone: 979-206-2288
  • Fax: 979-206-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELISSA SANCHEZ
Title or Position: RCM MANAGER
Credential:
Phone: 210-890-8840