MEDICARE: SCRUGGS FAMILY SERVICES, LLC

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	253Z00000X	In Home Supportive Care Agency	I000000008137	TN
2	253Z00000X	In Home Supportive Care Agency	L000000013954	TN

General Provider Information

NPI Number	:	1194018481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCRUGGS FAMILY SERVICES, LLC

Provider Business Mailing Address
First Line	:	9724 KINGSTON PIKE
Second Line	:	SUITE 1003
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6906
Country	:	US
Telephone Number	:	865-259-7770
Fax Number	:	865-622-5723

Provider Business Practice Location Address
First Line	:	9724 KINGSTON PIKE
Second Line	:	SUITE 1003
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6906
Country	:	US
Telephone Number	:	865-259-7770
Fax Number	:	865-622-5723

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBE
Name	:	MR. ANDREW C SCRUGGS
Credential	:
Telephone Number	:	865-259-7770

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/07/2014

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