Fast Pace Kentucky, PLLC
Organization Active NPI Rural Health Clinic/Center · Benton, KY
NPI 1427715770 · NPPES record last updated Nov 22, 2021
Key facts
- NPI
- 1427715770
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- FAST PACE KENTUCKY, PLLC
- Practice address
- 401 Main St
Benton, KY 42025-1119 - Phone
- (270) 906-0369
- NPI assigned
- Nov 22, 2021
- Organization subpart
- No
Authorized official
- Name
- Robert Benson
- Title
- Coo
- Phone
- (931) 253-1110
Owners & managing parties with NPI records 3
-
Dana Kay Martin, C.F.N.P.
-
Barry Louis Taylor, FNP
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 41
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2132061 | Fast Pace Kentucky, PLLC | Certificate of waiver | Jun 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Rural health clinic certification: CCN B03862
- 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
- Jan 24, 2025
- Ownership / control type
- 1B
- Organization structure
- Other · Proprietary
- Incorporated
- Dec 21, 2015 in KY
- Enrollment address
- 401 Main St
Benton, KY 42025-1119
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Barry Louis Taylor |
5% Or Greater Direct Ownership Interest | May 1, 2019 | 33.33% |
| Sydni Clemmons |
Corporate Director |
Dec 2, 2021 | |
| W-2 Managing Employee | Dec 2, 2021 | ||
| Karen Denise Daingerfield |
5% Or Greater Direct Ownership Interest | May 1, 2019 | 33.33% |
| Dana Kay Martin |
5% Or Greater Direct Ownership Interest | May 1, 2019 | 33.34% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220115000147 | KY | Part a Provider - Rural Health Clinic | 0143525998 |
1 other NPI on this enrollment Practice locations: Benton, KY |
National Provider Directory
- Tax ID family
- Fast Pace Kentucky PLLC
Locations
1873 Cumberland Falls Hwy
Corbin, KY 40701
Phone (606) 404-6450
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
401 Main St
Benton, KY 42025-1119
Mailing address
PO Box 306414
Nashville, TN 37230-6414
Other providers in Benton, KY
- Faye English
- Christina Joy Etheridge
- Stephanie Lynne Evans
- Tanner Evans
- Kristen Grace Farley
- Willard Jason Fiessinger
- Fiscal Court Marshall County
- Emily A Flowers
- H W Ford
- Lauren Nicole Ford
All providers in Benton, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2021. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.