MEDICARE: FAST TRACK URGENT CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RP1001X	Pulmonary Disease Physician
2	2084N0400X	Neurology Physician
3	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568087526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST TRACK URGENT CARE LLC

Provider Business Mailing Address
First Line	:	2400 NORTH BLVD W STE 1
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8980
Country	:	US
Telephone Number	:	252-469-3352
Fax Number	:	863-419-0025

Provider Business Practice Location Address
First Line	:	2400 NORTH BLVD W STE 1
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8980
Country	:	US
Telephone Number	:	402-720-4343
Fax Number	:	863-419-0025

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	NAEEM Z AHMED
Credential	:	MD
Telephone Number	:	402-720-4343

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	07/02/2020

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Directions to “FAST TRACK URGENT CARE LLC ” Practice Location

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