MEDICARE: HONORHEALTH-FASTMED AMBULATORY HOLDINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1366059982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONORHEALTH-FASTMED AMBULATORY HOLDINGS LLC

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	480-587-5314
Fax Number	:

Provider Business Practice Location Address
First Line	:	5259 W INDIAN SCHOOL RD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-2651
Country	:	US
Telephone Number	:	623-888-5101
Fax Number	:

Authorized Official
Title or Position	:	EVP/CPE
Name	:	JOHN NEIL
Credential	:
Telephone Number	:	480-587-5123

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	09/28/2020

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