1942027891 NPI number — FAST PACE KENTUCKY, PLLC

Table of content: (NPI 1942027891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942027891 NPI number — FAST PACE KENTUCKY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAST PACE KENTUCKY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942027891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 681029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37068-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-253-1110
Provider Business Mailing Address Fax Number:
931-722-9919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1635 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPINDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-330-9190
Provider Business Practice Location Address Fax Number:
828-330-9191
Provider Enumeration Date:
09/23/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARLAN
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CREDENTIALING
Authorized Official Telephone Number:
615-948-9639

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)