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FAST PACE MEDICAL CLINIC PLLC NPI 1952801334


NPI Information

NPI: 1952801334
Provider Name: FAST PACE MEDICAL CLINIC PLLC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 44D2290409

Address:
4152 W STATE ROAD 56
HANOVER, IN
ZIP 47243
Phone: (812) 762-4510
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FAST PACE MEDICAL CLINIC PLLC is a specialist in Hanover, IN. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. FAST PACE MEDICAL CLINIC PLLC NPI is 1952801334. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4152 W STATE ROAD 56
HANOVER, IN
ZIP 47243-070
Phone: (812) 762-4510

The provider's authorized official is Sydni Clemmons .
The authorized official title is Credentialing Manager and has the following contact phone number (901) 351-1791.

The CLIA number assigned to this NPI record is 44D2290409 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/13/2018 and was last updated on 7/15/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1PENDINGMEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.