MEDICARE: HENRY PATELFORD EWING M.D.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	07411	MS

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
2	730-01060	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1558361519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY PATELFORD EWING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7062
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38802-7062
Country	:	US
Telephone Number	:	662-377-7170
Fax Number	:	662-377-2423

Provider Business Practice Location Address
First Line	:	830 S GLOSTER ST
Second Line	:	NMMC EAST TOWER 4TH FLOOR
City	:	TUPELO
State	:	MS
Zip	:	38801-4934
Country	:	US
Telephone Number	:	662-377-7170
Fax Number	:	662-377-2423

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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