MEDICARE: MCEWEN FAMILY CLINIC PLLC

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	363LF0000X	Family Nurse Practitioner

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	:	1124116454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCEWEN FAMILY CLINIC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 306
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-0306
Country	:	US
Telephone Number	:	931-582-6681
Fax Number	:	931-582-3758

Provider Business Practice Location Address
First Line	:	9307 HWY 70 EAST
Second Line	:
City	:	MCEWEN
State	:	TN
Zip	:	37101
Country	:	US
Telephone Number	:	931-582-6681
Fax Number	:	931-582-3758

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID WARREN YANCEY
Credential	:	APN
Telephone Number	:	931-582-6681

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	05/21/2008

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