Provider Demographics
NPI:1972525012
Name:FASTCARE LLC
Entity type:Organization
Organization Name:FASTCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-923-4000
Mailing Address - Street 1:20601 E DIXIE HWY STE 340
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1542
Mailing Address - Country:US
Mailing Address - Phone:786-923-4000
Mailing Address - Fax:786-923-4001
Practice Address - Street 1:20601 E DIXIE HWY STE 340
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1542
Practice Address - Country:US
Practice Address - Phone:786-923-4000
Practice Address - Fax:786-923-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC1564OtherHEALTH CARE CLINIC LICENS
FLHCC1564OtherHEALTH CARE CLINIC LICENS
FLG84862Medicare UPIN
FLI12712Medicare UPIN
FLI17779Medicare UPIN
FL57614ZMedicare ID - Type UnspecifiedPORTNOY
FL48028ZMedicare ID - Type UnspecifiedHUANG
FLB904AMedicare ID - Type UnspecifiedFACILITY