Basic Information
| Provider Information | |||||||||
| NPI: | 1386309748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAST PACE MEDICAL CLINIC PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 306244 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372306244 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7449 STATE ROUTE 28 | ||||||||
| Address2: | |||||||||
| City: | DUNLAP | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373273564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234433262 | ||||||||
| FaxNumber: | 4234433273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2021 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | BENSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9312531110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 1515574 | 05 | TN | MEDICAID |