MEDICARE: MEDICAL SPECIALISTS OF JOHNSON CITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1083931539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SPECIALISTS OF JOHNSON CITY

Provider Business Mailing Address
First Line	:	2528 WESLEY ST STE 2
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1766
Country	:	US
Telephone Number	:	423-794-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	2528 WESLEY ST STE 2
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1766
Country	:	US
Telephone Number	:	423-794-2450
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS SERVICES
Name	:	AMANDA CLEAR
Credential	:
Telephone Number	:	423-794-2450

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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Directions to “MEDICAL SPECIALISTS OF JOHNSON CITY ” Practice Location

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