MEDICARE: MEDICAL SPECIALTIES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1265294300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SPECIALTIES PLLC

Provider Business Mailing Address
First Line	:	16850 STATE HIGHWAY 58 S STE A
Second Line	:
City	:	DECATUR
State	:	TN
Zip	:	37322-5259
Country	:	US
Telephone Number	:	423-507-7961
Fax Number	:

Provider Business Practice Location Address
First Line	:	16850 STATE HIGHWAY 58 S STE B
Second Line	:
City	:	DECATUR
State	:	TN
Zip	:	37322-5259
Country	:	US
Telephone Number	:	423-507-7961
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ENGLISH PAIGE ROBERTS
Credential	:	FNP
Telephone Number	:	423-507-7961

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	01/24/2024

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