MEDICARE: MULTISPECIALTY MEDICAL P.C.

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	207R00000X	Internal Medicine Physician	38563	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548392491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTISPECIALTY MEDICAL P.C.

Provider Business Mailing Address
First Line	:	1610 TAZEWELL RD
Second Line	:	SE 201
City	:	TAZEWELL
State	:	TN
Zip	:	37879-3600
Country	:	US
Telephone Number	:	423-626-8393
Fax Number	:	423-626-8749

Provider Business Practice Location Address
First Line	:	1610 TAZEWELL RD
Second Line	:	SE 201
City	:	TAZEWELL
State	:	TN
Zip	:	37879-3600
Country	:	US
Telephone Number	:	423-626-8393
Fax Number	:	423-626-8749

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. AMY LAMB
Credential	:
Telephone Number	:	423-626-8393

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	02/21/2013

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Directions to “MULTISPECIALTY MEDICAL P.C. ” Practice Location

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