Basic Information
| Provider Information | |||||||||
| NPI: | 1457716706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAST PACE KENTUCKY PLLC | ||||||||
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| OtherOrganizationName: | FAST PACE URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5141 VIRGINIA WAY | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159881571 | ||||||||
| FaxNumber: | 6159881635 | ||||||||
| Practice Location | |||||||||
| Address1: | 1475 NASHVILLE RD | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708131111 | ||||||||
| FaxNumber: | 2708131112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2015 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6159881574 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | KY | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QM1300X | KY | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 207Q00000X | KY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | KY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.