MEDICARE: LYNCHBURG FAMILY MEDICINE AND MINOR EMERGENCY CENTER PC

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	363A00000X	Physician Assistant	0872	TN

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	:	1659364669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNCHBURG FAMILY MEDICINE AND MINOR EMERGENCY CENTER PC

Provider Business Mailing Address
First Line	:	12 MAGNOLIA DR
Second Line	:
City	:	LYNCHBURG
State	:	TN
Zip	:	37352-8373
Country	:	US
Telephone Number	:	931-759-5044
Fax Number	:	931-759-5042

Provider Business Practice Location Address
First Line	:	12 MAGNOLIA DR
Second Line	:
City	:	LYNCHBURG
State	:	TN
Zip	:	37352-8373
Country	:	US
Telephone Number	:	931-759-5044
Fax Number	:	931-759-5042

Authorized Official
Title or Position	:	PA C
Name	:	TODD DWIGHT STEGALL
Credential	:	PA C
Telephone Number	:	931-759-5044

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/22/2008

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