MEDICARE: FAMILY HEALTH, LLC

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	261QP2300X	Primary Care Clinic/Center	19386	TN

General Provider Information

NPI Number	:	1700284825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH, LLC

Provider Business Mailing Address
First Line	:	106 MAIN ST
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4590
Country	:	US
Telephone Number	:	931-622-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 MAIN ST
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4590
Country	:	US
Telephone Number	:	931-622-1230
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TRACEY MACHELL HOOPER
Credential	:	NP-C
Telephone Number	:	931-622-1230

Provider Enumeration Date	:	12/06/2014
Last Update Date	:	12/06/2014

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Directions to “FAMILY HEALTH, LLC ” Practice Location

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