44D2145043 CLIA NUMBER - FAST PACE MEDICAL CLINIC, PLLC

Laboratory Demographics

CLIA Number: 44D2145043

Facility Name: FAST PACE MEDICAL CLINIC, PLLC

Facility Address:
502 ELLINGTON DRIVE
LAFAYETTE, TN
ZIP 37083
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Facility Phone Number: 931 253-1110

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1407511876

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2145043
LAB Type	Physician Office
Facility Name	FAST PACE MEDICAL CLINIC, PLLC
Street	502 ELLINGTON DRIVE
City	LAFAYETTE
State	TN
ZIP	37083
Phone	931 253-1110
CertificateType	4
CertificateEffectiveDate	2/27/2024
CertificateExpirationDate	2/26/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024