MEDICARE: MCEWEN MEDICAL 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1801459631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCEWEN MEDICAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 203
Second Line	:
City	:	MCEWEN
State	:	TN
Zip	:	37101
Country	:	US
Telephone Number	:	931-582-3170
Fax Number	:	931-582-3178

Provider Business Practice Location Address
First Line	:	10161 US HWY 70E
Second Line	:
City	:	MCEWEN
State	:	TN
Zip	:	37101
Country	:	US
Telephone Number	:	931-582-3170
Fax Number	:	931-582-3178

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DONNA SENSING
Credential	:
Telephone Number	:	931-582-3170

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	04/17/2019

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Directions to “MCEWEN MEDICAL LLC ” Practice Location

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