1821523382 NPI number — FASTPASS UCC, PLLC

Table of content: (NPI 1821523382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821523382 NPI number — FASTPASS UCC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FASTPASS UCC, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821523382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 TOWN AND COUNTRY BLVD STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-6913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-208-5297
Provider Business Mailing Address Fax Number:
214-260-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12600 ROLATER RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035-5188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-383-7543
Provider Business Practice Location Address Fax Number:
214-383-7544
Provider Enumeration Date:
04/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DE MOOR
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
AUTHORIZED OFFICIAL; CEO
Authorized Official Telephone Number:
469-320-9820

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 511138 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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