Healthcare Provider Details

I. General information

NPI: 1528727179
Provider Name (Legal Business Name): SPECIALTY CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 AL HIGHWAY 157
CULLMAN AL
35058-0656
US

IV. Provider business mailing address

2104 AL HIGHWAY 157
CULLMAN AL
35058-0656
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-3146
  • Fax: 256-734-2179
Mailing address:
  • Phone: 256-734-3146
  • Fax: 256-734-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK BROWN
Title or Position: AUTHORIZED OFFICIAL
Credential: PHARMD
Phone: 256-734-3146