44D2186846 CLIA NUMBER - FAST PACE MEDICAL CLINIC, PLLC

Laboratory Demographics

CLIA Number: 44D2186846

Facility Name: FAST PACE MEDICAL CLINIC, PLLC

Facility Address:
402 SOUTH BROAD STREET
NEW TAZEWELL, TN
ZIP 37825
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Facility Phone Number: 901 351-1791

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1265197545

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2186846
LAB Type	Physician Office
Facility Name	FAST PACE MEDICAL CLINIC, PLLC
Street	402 SOUTH BROAD STREET
City	NEW TAZEWELL
State	TN
ZIP	37825
Phone	901 351-1791
CertificateType	4
CertificateEffectiveDate	6/23/2022
CertificateExpirationDate	6/22/2024
FacilityType	Waiver

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