Provider Demographics
NPI:1801098264
Name:THE SPECIALTY CLINIC, PLLC
Entity type:Organization
Organization Name:THE SPECIALTY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, NP-C, WCC
Authorized Official - Phone:731-885-0063
Mailing Address - Street 1:201 W MAIN ST OFC PLAZA
Mailing Address - Street 2:SUITE G
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-2131
Mailing Address - Country:US
Mailing Address - Phone:731-885-0063
Mailing Address - Fax:731-885-0658
Practice Address - Street 1:201 W MAIN ST OFC PLAZA
Practice Address - Street 2:SUITE G
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-2131
Practice Address - Country:US
Practice Address - Phone:731-885-0063
Practice Address - Fax:731-885-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370157Medicaid
TN3370157Medicaid