Fasttrack Ic Ancillary LLC
Specialist in Dublin, GA. Organization (NPI-2).
NPI number1780134411
StatusActive
Last updated in NPPESOct 5, 2016
Details
- NPI
- 1780134411
- Entity type
- Organization (NPI-2)
- Legal business name
- Fasttrack Ic Ancillary LLC
- Organization subpart
- No
- Enumeration date
- Oct 5, 2016
- Last updated
- Oct 5, 2016
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | – | Yes |
Practice location
1110 Hillcrest PkwyUnit #c
Dublin, GA 31021-3687
Phone 478-296-2800
Mailing address
Po Box 4380Alpharetta, GA 30023-4380
Phone 888-728-0882
Authorized official
Jared Deraney
President
8887280882
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