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General NPI Number Information
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NPI Number | 1285399642
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Entity Type | Organization
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Legal Business Name | FAST PACE MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 750 US HIGHWAY 51 BYP W
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City | DYERSBURG
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State | TN
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Zip | 38024-1950
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Country | US
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Telephone | 731-325-3473
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Fax | 731-325-3474
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Provider Business Mailing Address
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Address Line | PO BOX 306244
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City | NASHVILLE
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State | TN
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Zip | 37230-6244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ROBERT BENSON
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Credential |
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Telephone | 931-253-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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