MEDICARE: WYCHE & WYCHE, M.D., 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1023131281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYCHE & WYCHE, M.D., P.C.

Provider Business Mailing Address
First Line	:	2406 SUSANNAH ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1725
Country	:	US
Telephone Number	:	423-282-2542
Fax Number	:	423-282-5447

Provider Business Practice Location Address
First Line	:	2406 SUSANNAH ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1725
Country	:	US
Telephone Number	:	423-282-2542
Fax Number	:	423-282-5447

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. MARY Y. WYCHE
Credential	:	M.D.
Telephone Number	:	423-282-2542

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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