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General NPI Number Information
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NPI Number | 1053051508
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Entity Type | Organization
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Legal Business Name | MEDICAL SPECTRUM LLC
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Dates
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Enumeration Date | 03/31/2022
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 1295 CHATTAHOOCHEE AVE NW
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City | ATLANTA
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State | GA
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Zip | 30318-3648
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Country | US
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Telephone | 312-909-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 9836 ONTARIO ST
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City | OMAHA
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State | NE
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Zip | 68124-3758
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Country | US
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Telephone | 402-680-0509
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | THOMAS E HENRY
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Credential |
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Telephone | 402-680-0509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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