MEDICARE: STORGE MEDICAL GROUP 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1881367589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STORGE MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	3506 BROAD ST
Second Line	:
City	:	LISMAN
State	:	AL
Zip	:	36912-2843
Country	:	US
Telephone Number	:	205-457-4022
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CRAWFORD ST STE 1125
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-9008
Country	:	US
Telephone Number	:	205-457-4022
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	MRS. SHARON KNIGHTON
Credential	:
Telephone Number	:	205-457-4022

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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Directions to “STORGE MEDICAL GROUP LLC ” Practice Location

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