MEDICARE: LUTZ FAMILY CARE CLINIC, PLLC

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

General Provider Information

NPI Number	:	1770523508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTZ FAMILY CARE CLINIC, PLLC

Provider Business Mailing Address
First Line	:	106 MAIN ST
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4590
Country	:	US
Telephone Number	:	931-582-8820
Fax Number	:	931-582-8970

Provider Business Practice Location Address
First Line	:	106 MAIN ST
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4590
Country	:	US
Telephone Number	:	931-582-8820
Fax Number	:	931-582-8970

Authorized Official
Title or Position	:	OWNER / MEMBER
Name	:	DAVID A LUTZ SR.
Credential	:	P.A.-C
Telephone Number	:	931-582-8820

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/22/2020

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