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General NPI Number Information
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NPI Number | 1336491968
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Entity Type | Organization
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Legal Business Name | FASTMED URGENT CARE
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 890 W ELLIOT RD
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City | GILBERT
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State | AZ
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Zip | 85233-5102
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Country | US
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Telephone | 480-585-2787
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Fax | 480-545-1458
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Provider Business Mailing Address
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Address Line | 800 W ELLIOT ROAD SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MISS TRUDY JAMES
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Credential |
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Telephone | 480-585-2787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | AZ
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