Basic Information
| Provider Information | |||||||||
| NPI: | 1134452865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAST PACE MEDICAL CLINIC PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1258 | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384851258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317229099 | ||||||||
| FaxNumber: | 9317229919 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E TENNESSEE ST | ||||||||
| Address2: | |||||||||
| City: | COLLINWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317249000 | ||||||||
| FaxNumber: | 7317245577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2009 | ||||||||
| LastUpdateDate: | 05/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | BEVIS | ||||||||
| AuthorizedOfficialFirstName: | STANLEY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9312531110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | TN | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1515574 | 05 | TN | MEDICAID |