MEDICARE: MASTERS FAMILY MEDICAL, 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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902669682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTERS FAMILY MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 90
Second Line	:
City	:	CLARKRANGE
State	:	TN
Zip	:	38553-0118
Country	:	US
Telephone Number	:	931-310-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 CENTRAL AVE W
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-3557
Country	:	US
Telephone Number	:	931-879-8139
Fax Number	:	931-879-0221

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	ALISHA N MASTERS
Credential	:	FNP
Telephone Number	:	931-310-2900

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	04/07/2026

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