Provider Demographics
NPI:1548392491
Name:MULTISPECIALTY MEDICAL P.C.
Entity Type:Organization
Organization Name:MULTISPECIALTY MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-626-8393
Mailing Address - Street 1:1610 TAZEWELL RD
Mailing Address - Street 2:SE 201
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3600
Mailing Address - Country:US
Mailing Address - Phone:423-626-8393
Mailing Address - Fax:423-626-8749
Practice Address - Street 1:1610 TAZEWELL RD
Practice Address - Street 2:SE 201
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3600
Practice Address - Country:US
Practice Address - Phone:423-626-8393
Practice Address - Fax:423-626-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370382Medicaid
TN3370382Medicaid
TNI11168Medicare UPIN