Sewanee Family Practice PLLC
Organization Active NPI Family Medicine Physician · Sewanee, TN
NPI 1063817625 · NPPES record last updated Oct 24, 2014
Key facts
- NPI
- 1063817625
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 34975 (TN)
- Legal business name
- SEWANEE FAMILY PRACTICE PLLC
- Practice address
- 1314 University Ave
Sewanee, TN 37375-2336 - Phone
- (931) 598-5648
- Fax
- (931) 598-0778
- NPI assigned
- Oct 24, 2014
- Organization subpart
- No
Authorized official
- Name
- Louis E Koella, MD
- Title
- Presiedent
- Phone
- (931) 598-5648
Practitioners 6
-
Melanie Prince Sullivan, CRNP
-
Catherine Lynn Martin, PHYSICIAN ASSISTANT
-
Rita Milner, APRN,BC
-
Diane L Petrilla, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150310001114 | TN | Part B Supplier - Clinic/Group Practice | 1951627900 |
Receives reassigned benefits from 3 practitioners Practice locations: Sewanee, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 34975 | TN | Yes |
| Family Medicine Physician |
207Q00000X | 713 | TN | |
| Family Medicine Physician |
207Q00000X | 1376 | TN |
Addresses
Primary practice location
1314 University Ave
Sewanee, TN 37375-2336
Mailing address
PO Box 700
Sewanee, TN 37375-0700
Phone (931) 598-5648
Other providers in Sewanee, TN
- Mary Pate-Bennett
- Matthew J Petrilla
- Robin Allison Reed-Spaulding
- Gerre L Schwert
- Devon Forbes Frances Serrano
- Sewanee Pediatrics and Adolescent Medicine PLLC
- Anne Milner Sitz
- Austin Stevens
- Jeffrey Alton Stirnemann
- Laurel Elise Anderson Tarhan
All providers in Sewanee, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.