Basic Information
| Provider Information | |||||||||
| NPI: | 1861646432 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FASTRAX URGENT CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 STOCKTON HILL RD | ||||||||
| Address2: | STE | ||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864014698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287533303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2002 STOCKTON HILL RD | ||||||||
| Address2: | STE | ||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864014698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287533303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2008 | ||||||||
| LastUpdateDate: | 11/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHMIDT | ||||||||
| AuthorizedOfficialFirstName: | DONOVAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9287533303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | OTC3597 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.