MEDICARE: JEWELL MINNICH

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1124285655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEWELL MINNICH

Provider Business Mailing Address
First Line	:	201 W SPRINGDALE AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-5158
Country	:	US
Telephone Number	:	865-329-9173
Fax Number	:	865-541-6941

Provider Business Practice Location Address
First Line	:	526 LAMAR ST
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-7343
Country	:	US
Telephone Number	:	865-544-3841
Fax Number	:	865-541-3843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	10/28/2019

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Directions to “ JEWELL MINNICH ” Practice Location

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