Healthcare Provider Details

I. General information

NPI: 1447915749
Provider Name (Legal Business Name): FAST PACE MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5554 HIGHWAY 11 E
PINEY FLATS TN
37686-4435
US

IV. Provider business mailing address

PO BOX 306244
NASHVILLE TN
37230-6244
US

V. Phone/Fax

Practice location:
  • Phone: 423-666-0030
  • Fax: 423-666-0031
Mailing address:
  • Phone:
  • Fax:

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