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General NPI Number Information
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NPI Number | 1598134579
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Entity Type | Organization
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Legal Business Name | HEALTHFAST MEDICAL, PLLC
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Dates
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Enumeration Date | 09/19/2015
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 560 US HIGHWAY 271 S
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City | GILMER
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State | TX
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Zip | 76544
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Country | US
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Telephone | 903-680-8000
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Fax | 903-680-8001
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Provider Business Mailing Address
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Address Line | PO BOX 970
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City | GILMER
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State | TX
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Zip | 75644-0970
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Country | US
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Telephone | 903-452-7824
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Fax |
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Authorized Official
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Title or Position | PA/OWNER
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Name | MR. MATTHEW S ROBERTS
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Credential | PA-C
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Telephone | 993-680-8000
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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 | PA07367
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA07367
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License Number State | TX
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