NPIMap

Organization Active NPI

Fast Pace Kentucky, PLLC

  • Rural Health Clinic/Center
  • Central City, KY
National Provider Identifier
1255098505
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAST PACE KENTUCKY, PLLC
Practice address
110 S 2ND St
Central City, KY 42330-1506
Phone
(270) 931-2059
NPI assigned
Nov 22, 2021
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Robert Benson
Title
Coo
Phone
(931) 253-1110

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2130859Fast Pace Kentucky, PLLC110 S Second Street, Central City, KY 42330Certificate of waiverMay 17, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Rural health clinic certification: CCN B03864

Legal name
FAST PACE KENTUCKY, PLLC
Doing business as
FAST PACE HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 11, 2022
Last certification
Feb 11, 2022
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Dec 21, 2015 in KY
Enrollment address
110 S 2ND St
Central City, KY 42330-1506

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220108000186 KY Part a Provider - Rural Health Clinic 0143525998 Practice locations: Central City, KY

All disclosed owners & managing parties 4

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Barry Louis Taylor Individual 5% Or Greater Direct Ownership Interest May 1, 2019 33.33%
Sydni Clemmons Individual Corporate Director Dec 2, 2021
W-2 Managing Employee Dec 2, 2021
Karen Denise Daingerfield Individual 5% Or Greater Direct Ownership Interest May 1, 2019 33.33%
Dana Kay Martin Individual 5% Or Greater Direct Ownership Interest May 1, 2019 33.33%

National Provider Directory

National Provider Directory
Tax ID family
Fast Pace Kentucky PLLC42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Locations

110 S 2nd St
Central City, KY 42330
Phone (270) 931-2059

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

110 S 2ND St
Central City, KY 42330-1506

Mailing address

PO Box 306414
Nashville, TN 37230-6414

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 22, 2021.

{
    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637539200000",
    "number": "1255098505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306414",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S 2ND ST",
            "city": "CENTRAL CITY",
            "state": "KY",
            "postal_code": "423301506",
            "telephone_number": "270-931-2059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE KENTUCKY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A",
        "authorized_official_last_name": "BENSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "931-253-1110"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Central City, KY

Sources for this page

Verify at the official NPI Registry.