| Entity Name: | FAST TRACK URGENT CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 13 Feb 2020 (5 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L20000043927 |
| Address: | 2400 NORTH BLVD WEST, DAVENPORT, FL 33837 |
| Mail Address: | 2400 NORTH BLVD WEST, DAVENPORT, FL 33837 |
| ZIP code: | 33837 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568087526 | 2020-06-15 | 2020-07-02 | 2400 NORTH BLVD W STE 1, DAVENPORT, FL, 338378980, US | 2400 NORTH BLVD W STE 1, DAVENPORT, FL, 338378980, US | |||||||||||||||||||||||||||||||
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| Phone | +1 252-469-3352 |
| Fax | 8634190025 |
| Phone | +1 402-720-4343 |
Authorized person
| Name | NAEEM Z AHMED |
| Role | CHIEF MEDICAL OFFICER |
| Phone | 4027204343 |
Taxonomy
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | No |
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100924200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KHAN, KASHAN | Agent | 2400 NORTH BLVD WEST, DAVENPORT, FL 33837 |
| Name | Role | Address |
|---|---|---|
| KHAN, KASHAN | Member | 2400 NORTH BLVD WEST, DAVENPORT, FL 33837 |
| AHMED, NAEEM | Member | 2400 NORTH BLVD WEST, DAVENPORT, FL 33837 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2020-02-13 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
