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General NPI Number Information
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NPI Number | 1649770769
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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 | 02/15/2018
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 4152 W STATE ROAD
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City | HANOVER
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State | IN
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Zip | 47243
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Country | US
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Telephone | 931-253-1110
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Fax | 931-722-9919
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Provider Business Mailing Address
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Address Line | PO BOX 1258
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City | WAYNESBORO
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State | TN
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Zip | 38485-1258
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Country | US
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Telephone | 931-253-1110
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Fax | 931-722-9919
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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