Healthcare Provider Details

I. General information

NPI: 1730165705
Provider Name (Legal Business Name): MED-PLUS MUSCLE SHOALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 AVALON AVE
MUSCLE SHOALS AL
35661-2800
US

IV. Provider business mailing address

108 AVALON AVE
MUSCLE SHOALS AL
35661-2800
US

V. Phone/Fax

Practice location:
  • Phone: 256-389-9300
  • Fax: 256-389-9367
Mailing address:
  • Phone: 256-389-9300
  • Fax: 256-389-9367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY J TEAGUE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000