Fast Pace Medical Clinic, PLLC
Organization Active NPI Orthopaedic Surgery Physician · Lincoln, AL
NPI 1124528468 · NPPES record last updated Oct 11, 2022
Key facts
- NPI
- 1124528468
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- FAST PACE MEDICAL CLINIC, PLLC
- Practice address
- 25 Bear Pkwy
Lincoln, AL 35096-6798 - Phone
- (423) 746-5973
- NPI assigned
- Feb 13, 2018
- Organization subpart
- No
Authorized official
- Name
- Sydni Clemmons
- Title
- Coo
- Phone
- (931) 253-1110
Owners & managing parties with NPI records 3
-
Selena Michelle Gurley, CRNP
-
Dana Kay Martin, C.F.N.P.
Other NPIs on the same Medicare enrollment 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Rural health clinic certification: CCN 883900
- Legal name
- FAST PACE MEDICAL CLINIC PLLC
- Doing business as
- FAST PACE HEALTH
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 21, 2022
- Last certification
- Jan 21, 2022
- Ownership / control type
- 1A
- Organization structure
- Other · Proprietary
- Incorporated
- Oct 5, 2009 in TN
- Enrollment address
- 1019 Decatur Pike
Athens, TN 37303-3039
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Selena Michelle Gurley |
5% Or Greater Direct Ownership Interest | May 10, 2019 | 33.33% |
| Sydni Clemmons |
Corporate Director |
Nov 1, 2021 | |
| W-2 Managing Employee | Nov 1, 2021 | ||
| Karen Denise Daingerfield |
5% Or Greater Direct Ownership Interest | May 10, 2019 | 33.33% |
| Fpmcm, LLC |
Operational/Managerial Control | Oct 5, 2009 | 100% |
| Dana Kay Martin |
5% Or Greater Direct Ownership Interest | May 10, 2019 | 33.33% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211229002441 | TN | Part a Provider - Rural Health Clinic | 5395881841 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Athens, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes | ||
| Rural Health Clinic/Center | 261QR1300X |
Addresses
Primary practice location
25 Bear Pkwy
Lincoln, AL 35096-6798
Mailing address
6550 Carothers Pkwy Ste 225
Franklin, TN 37067-6662
Phone (931) 253-1110
Other providers in Lincoln, AL
- Downey Eyecare
- Stephen Carey Downey
- Fast Pace Medical Clinic PLLC
- Fast Pace Medical Clinic PLLC
- Fast Pace Medical Clinic PLLC
- Hannah Boone Faulkner
- Christy Hill Fuller
- Amaris Garrett
- Sonja George
- Kassidy Lynn Goins
All providers in Lincoln, AL · Orthopaedic Surgery Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.