Basic Information
| Provider Information | |||||||||
| NPI: | 1407413974 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SYNERGIC HEALTHCARE SOLUTIONS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TGH URGENT CARE POWERED BY FAST TRACK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15490 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852675490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184244008 | ||||||||
| FaxNumber: | 8552301466 | ||||||||
| Practice Location | |||||||||
| Address1: | 16521 S US HIGHWAY 301 | ||||||||
| Address2: | |||||||||
| City: | WIMAUMA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335982032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139251903 | ||||||||
| FaxNumber: | 8137498370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 01/08/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | DIECIDUE | ||||||||
| AuthorizedOfficialFirstName: | DARON | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8139251903 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.