MEDICARE: FAST PACE MEDICAL CLINIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	261Q00000X	Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center	TN
3	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134452865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST PACE MEDICAL CLINIC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1258
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-1258
Country	:	US
Telephone Number	:	931-722-9099
Fax Number	:	931-722-9919

Provider Business Practice Location Address
First Line	:	3813 OLD PORT ROYAL RD N
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2813
Country	:	US
Telephone Number	:	931-487-1006
Fax Number	:

Authorized Official
Title or Position	:	SR MANAGER
Name	:	CHRISTY LITTLEJOHN
Credential	:
Telephone Number	:	931-253-1110

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	11/21/2024

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