Basic Information
Provider Information | |||||||||
NPI: | 1861902223 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SYNERGIC HEALTHCARE SOLUTIONS LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FAST TRACK URGENT CARE CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 15490 | ||||||||
Address2: |   | ||||||||
City: | SCOTTSDALE | ||||||||
State: | AZ | ||||||||
PostalCode: | 852675490 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3184244008 | ||||||||
FaxNumber: | 8552301466 | ||||||||
Practice Location | |||||||||
Address1: | 7601 SEMINOLE BLVD | ||||||||
Address2: |   | ||||||||
City: | SEMINOLE | ||||||||
State: | FL | ||||||||
PostalCode: | 337724868 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8139251903 | ||||||||
FaxNumber: | 8137498370 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/11/2017 | ||||||||
LastUpdateDate: | 12/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DIECIDUE | ||||||||
AuthorizedOfficialFirstName: | DARON | ||||||||
AuthorizedOfficialMiddleName: | G. | ||||||||
AuthorizedOfficialTitleorPosition: | MEMBER MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8139251903 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: | 12/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.