MEDICARE: SCOTTSBORO OB GYN SPECIALISTS 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	207V00000X	Obstetrics & Gynecology Physician

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	:	1972658300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTTSBORO OB GYN SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	408 TAYLOR ST
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2424
Country	:	US
Telephone Number	:	256-259-5211
Fax Number	:	256-259-6641

Provider Business Practice Location Address
First Line	:	408 TAYLOR ST
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2424
Country	:	US
Telephone Number	:	256-259-5211
Fax Number	:	256-259-6641

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MELISSA CAMPBELL
Credential	:
Telephone Number	:	256-259-5211

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	03/14/2011

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