MEDICARE: MANCHESTER FAMILY PRACTICE

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	207Q00000X	Family Medicine Physician	MD0000025899	TN

General Provider Information

NPI Number	:	1568742963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANCHESTER FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	119 E FORT ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-1508
Country	:	US
Telephone Number	:	931-728-4477
Fax Number	:	931-680-9835

Provider Business Practice Location Address
First Line	:	119 E FORT ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-1508
Country	:	US
Telephone Number	:	931-728-4477
Fax Number	:	931-680-9835

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LORRI MCGOWAN
Credential	:
Telephone Number	:	931-728-4477

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	08/17/2011

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Directions to “MANCHESTER FAMILY PRACTICE ” Practice Location

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