Healthcare Provider Details

I. General information

NPI: 1235639584
Provider Name (Legal Business Name): FAST PACE MEDICAL CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N MAIN ST
MT PLEASANT TN
38474-1017
US

IV. Provider business mailing address

PO BOX 306244
NASHVILLE TN
37230-6244
US

V. Phone/Fax

Practice location:
  • Phone: 931-379-3229
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax: 931-722-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BENSON
Title or Position: COO
Credential:
Phone: 931-253-1110