Provider Demographics
NPI:1033120043
Name:FAMILY MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:YUH-JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-588-0076
Mailing Address - Street 1:4700 WESTERN AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3320
Mailing Address - Country:US
Mailing Address - Phone:865-588-0076
Mailing Address - Fax:865-588-0076
Practice Address - Street 1:4700 WESTERN AVE
Practice Address - Street 2:STE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3320
Practice Address - Country:US
Practice Address - Phone:865-588-2902
Practice Address - Fax:865-584-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3705139Medicaid
TN3705139Medicaid