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	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1548002348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST PACE MEDICAL CLINIC PLLC

Provider Business Mailing Address
First Line	:	6550 CAROTHERS PKWY
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6693
Country	:	US
Telephone Number	:	615-364-1773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1797 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3226
Country	:	US
Telephone Number	:	423-830-0516
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MELISSA HARLAN
Credential	:
Telephone Number	:	615-948-9639

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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