Fast Pace Medical Clinic PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

FAST PACE MEDICAL CLINIC PLLC

Practice address

4152 W State Road 56
Hanover, IN 47243-9070

Phone

(812) 762-4510

NPI assigned

Feb 13, 2018

Last updated

Jul 15, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sydni Clemmons

Title

Credentialing Manager

Phone

(901) 351-1791

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Fast Pace Medical Clinic PLLC133 organizations share this tax ID, including this one

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1952801334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1258",
            "city": "WAYNESBORO",
            "state": "TN",
            "postal_code": "384851258",
            "telephone_number": "931-253-1110",
            "fax_number": "931-722-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4152 W STATE ROAD 56",
            "city": "HANOVER",
            "state": "IN",
            "postal_code": "472439070",
            "telephone_number": "812-762-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAST PACE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-13",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "CLEMMONS",
        "authorized_official_first_name": "SYDNI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "901-351-1791"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daviess County Hospital (Aperion Care Hanover)
• Davis Elderly Care, LLC
• Marc Eilers, ATC
• Jerry Wayne Eversole, LPN
• Fast Pace Medical Clinic PLLC
• Barbara A Ford, O.T.R., C.L.T.
• Kris Yvonne Fultz, RN
• Christopher Gerard Goeppner, RPH
• Ashley Gray
• Diane Marie Hagan, PT

• Specialist in Hanover, IN
• Providers in Hanover, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.