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1952801334 NPI number — FAST PACE MEDICAL CLINIC PLLC

NPI Number: 1952801334
Health Care Provider/Practitioner: FAST PACE MEDICAL CLINIC PLLC

Information about “1952801334” NPI (FAST PACE MEDICAL CLINIC PLLC) exists in 1952801334 in HTML format HTML  |  1952801334 in plain Text format TXT  |  1952801334 in PDF (Portable Document Format) PDF  |  1952801334 in an XML format XML  formats.

NPI Number : 1952801334 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952801334",
    "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": "931-253-1110",
    "MailingAddressFaxNumber": "931-722-9919",
    "FirstLinePracticeLocationAddress": "4152 W STATE ROAD 56",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HANOVER",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47243-9070",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-762-4510",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/13/2018",
    "LastUpdateDate": "07/15/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CLEMMONS",
    "AuthorizedOfficialFirstName": "SYDNI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CREDENTIALING MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "901-351-1791",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "174400000X",
        "TaxonomyName": "Specialist",
        "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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