=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316716400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAST TRACK MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2023
-----------------------------------------------------
Last Update Date | 04/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 916 OLIVE ST STE 2
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63101-1459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-436-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 916 OLIVE ST STE 2
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63101-1459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-436-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | RENITA JEANETTE BARRINGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-436-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------