Provider Demographics
NPI:1104920685
Name:COWAN FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:COWAN FAMILY MEDICINE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SOMMERSCHIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-962-1345
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-0129
Mailing Address - Country:US
Mailing Address - Phone:931-962-1345
Mailing Address - Fax:931-967-6439
Practice Address - Street 1:2230 COWAN HWY STE B
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2627
Practice Address - Country:US
Practice Address - Phone:931-962-1345
Practice Address - Fax:931-967-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3333230Medicaid
TN1013941319OtherNPI FOR INDIVIDUAL PROV
TN1013941319OtherNPI FOR INDIVIDUAL PROV
TN3333231Medicare PIN