Healthcare Provider Details

I. General information

NPI: 1053836767
Provider Name (Legal Business Name): MERCEDEZ MARIE SPEICHER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARRISON PLZ
FLORENCE AL
35632-0002
US

IV. Provider business mailing address

3410 CHISHOLM RD
FLORENCE AL
35630-6351
US

V. Phone/Fax

Practice location:
  • Phone: 256-765-4635
  • Fax:
Mailing address:
  • Phone: 319-239-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number1992
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: