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1134452865 NPI number — FAST PACE MEDICAL CLINIC PLLC

NPI Number: 1134452865
Health Care Provider/Practitioner: FAST PACE MEDICAL CLINIC PLLC

Information about “1134452865” NPI (FAST PACE MEDICAL CLINIC PLLC) exists in 1134452865 in HTML format HTML  |  1134452865 in plain Text format TXT  |  1134452865 in PDF (Portable Document Format) PDF  |  1134452865 in an XML format XML  formats.

NPI Number : 1134452865 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134452865",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FAST PACE MEDICAL CLINIC PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1258",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAYNESBORO",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38485-1258",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "931-722-9099",
    "MailingAddressFaxNumber": "931-722-9919",
    "FirstLinePracticeLocationAddress": "3813 OLD PORT ROYAL RD N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPRING HILL",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37174-2813",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "931-487-1006",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/14/2009",
    "LastUpdateDate": "11/21/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LITTLEJOHN",
    "AuthorizedOfficialFirstName": "CHRISTY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "SR MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "931-253-1110",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QU0200X",
          "TaxonomyName": "Urgent Care Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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