Healthcare Provider Details

I. General information

NPI: 1043246630
Provider Name (Legal Business Name): SPECIALTY MEDICINE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 COMMONS BLVD STE 120
BEAVERCREEK OH
45431-3827
US

IV. Provider business mailing address

2633 COMMONS BLVD STE 120
BEAVERCREEK OH
45431-3827
US

V. Phone/Fax

Practice location:
  • Phone: 937-429-0607
  • Fax: 937-702-9041
Mailing address:
  • Phone: 937-429-0607
  • Fax: 937-702-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TROY A TYNER
Title or Position: PRESIDENT
Credential: DO
Phone: 937-429-0607