=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619542297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAST CARE DIAGNOSTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2021
-----------------------------------------------------
Last Update Date | 05/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 PATRIOT BLVD STE 250
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60026-8021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-339-1710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 PATRIOT BLVD STE 250
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60026-8021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-339-1710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | NURUDEEN HASSAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-877-2009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------