MEDICARE: FAST PACE KENTUCKY PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	261QU0200X	Urgent Care Clinic/Center	KY
2	261QM1300X	Multi-Specialty Clinic/Center	KY
3	207Q00000X	Family Medicine Physician	KY
4	363LF0000X	Family Nurse Practitioner	KY

General Provider Information

NPI Number	:	1457716706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST PACE KENTUCKY PLLC

Provider Business Mailing Address
First Line	:	5141 VIRGINIA WAY
Second Line	:	SUITE 390
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7572
Country	:	US
Telephone Number	:	615-988-1571
Fax Number	:	615-988-1635

Provider Business Practice Location Address
First Line	:	1475 NASHVILLE RD
Second Line	:
City	:	FRANKLIN
State	:	KY
Zip	:	42134
Country	:	US
Telephone Number	:	270-813-1111
Fax Number	:	270-813-1112

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. MATT DAVIS
Credential	:
Telephone Number	:	615-988-1574

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	10/15/2021

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