15D2190827 CLIA NUMBER - FAST PACE MEDICAL CLINIC PLLC

Laboratory Demographics

  • CLIA Code: 15D2190827
  • Facility Name: FAST PACE MEDICAL CLINIC PLLC
  • Facility Address: 4152 W STATE ROAD 56
    HANOVER, IN
    ZIP 47243
  • Facility Phone: 901 351-1791
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SELENA GURLEY
  • NPI Number: 1982361259
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2190827
LAB Type Physician Office
Facility Name FAST PACE MEDICAL CLINIC PLLC
Street 4152 W STATE ROAD 56
City HANOVER
State IN
ZIP 47243
Phone 901 351-1791
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Physician Office
Lab Director SELENA GURLEY

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This page was last updated on: 9/29/2025