NPI Code Detail JSON Logo

1891604773 NPI number — FASTTRACK MEDICAL, LLC

NPI Number: 1891604773
Health Care Provider/Practitioner: FASTTRACK MEDICAL, LLC

Information about “1891604773” NPI (FASTTRACK MEDICAL, LLC) exists in 1891604773 in HTML format HTML  |  1891604773 in plain Text format TXT  |  1891604773 in PDF (Portable Document Format) PDF  |  1891604773 in an XML format XML  formats.

NPI Number : 1891604773 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891604773",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FASTTRACK MEDICAL, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "201 S 36TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MUSKOGEE",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "74401-5079",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "918-600-2701",
    "MailingAddressFaxNumber": "539-390-3009",
    "FirstLinePracticeLocationAddress": "201 S 36TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MUSKOGEE",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "74401-5079",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "918-600-2701",
    "PracticeLocationAddressFaxNumber": "539-390-3009",
    "EnumerationDate": "09/04/2026",
    "LastUpdateDate": "09/04/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FORREST",
    "AuthorizedOfficialFirstName": "JOSHUA",
    "AuthorizedOfficialMiddleName": "W",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "918-805-4885",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WI0500X",
          "TaxonomyName": "Infusion Therapy Registered Nurse",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM1300X",
          "TaxonomyName": "Multi-Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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