| Sewanee Family Practice Pllc | |
|
1314 University Ave Sewanee TN 37375-2336 | |
| (931) 598-5648 | |
| (931) 598-0778 |
| Full Name | Sewanee Family Practice Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1314 University Ave, Sewanee, Tennessee |
| Authorized Official Name and Position | Louis E Koella (PRESIEDENT) |
| Authorized Official Contact | 9315985648 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sewanee Family Practice Pllc Po Box 700 Sewanee TN 37375-0700 Ph: (931) 598-5648 | Sewanee Family Practice Pllc 1314 University Ave Sewanee TN 37375-2336 Ph: (931) 598-5648 |
| NPI Number | 1063817625 |
|---|---|
| Provider Enumeration Date | 10/24/2014 |
| Last Update Date | 10/24/2014 |
| Medicare PECOS PAC ID | 1951627900 |
|---|---|
| Medicare Enrollment ID | O20150310001114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063817625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 34975 (Tennessee) | Primary |
| 207Q00000X | Family Medicine | 713 (Tennessee) | Secondary |
| 207Q00000X | Family Medicine | 1376 (Tennessee) | Secondary |
| Provider Name | David C Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902809718 PECOS PAC ID: 6800858739 Enrollment ID: I20041102000669 |
| Provider Name | Matthew James Petrilla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811967532 PECOS PAC ID: 8224065115 Enrollment ID: I20101019000408 |
Sewanee Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1314 University Ave., Sewanee, TN 37375 Phone: 931-598-5648 Fax: 931-598-0778 | |
Lawrence William Costa, Jr. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1410 University Ave, Sewanee, TN 37375 Phone: 931-924-4200 | |
Southern Tennessee Pediatrics - Sewanee Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1318 University Ave, Sewanee, TN 37375 Phone: 931-598-9761 | |
University Of The South Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1310 University Ave, Spo 1182, Sewanee, TN 37375 Phone: 931-598-1270 Fax: 931-598-1746 |