MEDICARE: DIABETES SPECIALITY CARE AND ASSOCIATES LLC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1407748395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES SPECIALITY CARE AND ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	3815 HIGHWAY 66 S STE 5
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-5197
Country	:	US
Telephone Number	:	423-293-0202
Fax Number	:	423-293-0102

Provider Business Practice Location Address
First Line	:	3815 HIGHWAY 66 S STE 5
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-5197
Country	:	US
Telephone Number	:	423-293-0202
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	PAMELA ANNE REINERS
Credential	:
Telephone Number	:	731-571-9223

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	10/22/2025

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