MEDICARE: FAST PACE MEDICAL CLINIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407511876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST PACE MEDICAL CLINIC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 306244
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 ELLINGTON DR
Second Line	:
City	:	LAFAYETTE
State	:	TN
Zip	:	37083-1697
Country	:	US
Telephone Number	:	615-561-1042
Fax Number	:	615-561-1043

Authorized Official
Title or Position	:	COO
Name	:	ROBERT BENSON
Credential	:
Telephone Number	:	931-253-1110

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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