MEDICARE: STEELE MEDICAL CLINIC 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1720726391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEELE MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	1757 HIGHWAY 178 W STE A
Second Line	:
City	:	MYRTLE
State	:	MS
Zip	:	38650-9233
Country	:	US
Telephone Number	:	662-988-7041
Fax Number	:	662-988-7052

Provider Business Practice Location Address
First Line	:	1757 HIGHWAY 178 W STE A
Second Line	:
City	:	MYRTLE
State	:	MS
Zip	:	38650-9233
Country	:	US
Telephone Number	:	662-988-7041
Fax Number	:	662-988-7052

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT STEELE IV
Credential	:	PA
Telephone Number	:	662-471-1805

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	10/04/2022

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