15D2304995 CLIA NUMBER - FAST PACE MEDICAL CLINIC PLLC

Laboratory Demographics

  • CLIA Code: 15D2304995
  • Facility Name: FAST PACE MEDICAL CLINIC PLLC
  • Facility Address: 3536 PROMENADE PARKWAY
    LAFAYETTE, IN
    ZIP 47909
  • Facility Phone: 931 253-1110
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SELENA GURLEY
  • NPI Number: 1518626225
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2304995
LAB Type Practitioner Other
Facility Name FAST PACE MEDICAL CLINIC PLLC
Street 3536 PROMENADE PARKWAY
City LAFAYETTE
State IN
ZIP 47909
Phone 931 253-1110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2024
Certificate Expiration Date 5/21/2026
Facility Type Practitioner Other
Lab Director SELENA GURLEY

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