Provider Demographics
NPI:1265294300
Name:MEDICAL SPECIALTIES PLLC
Entity type:Organization
Organization Name:MEDICAL SPECIALTIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENGLISH
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-507-7961
Mailing Address - Street 1:16850 STATE HIGHWAY 58 S STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-5259
Mailing Address - Country:US
Mailing Address - Phone:423-507-7961
Mailing Address - Fax:
Practice Address - Street 1:16850 STATE HIGHWAY 58 S STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-5259
Practice Address - Country:US
Practice Address - Phone:423-507-7961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty