Provider Demographics
NPI:1497126700
Name:JOHN C MCKEOWN, MD
Entity Type:Organization
Organization Name:JOHN C MCKEOWN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-472-7938
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:TN
Mailing Address - Zip Code:37365-0100
Mailing Address - Country:US
Mailing Address - Phone:931-779-3691
Mailing Address - Fax:931-779-3690
Practice Address - Street 1:2578 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:TN
Practice Address - Zip Code:37365-2730
Practice Address - Country:US
Practice Address - Phone:931-779-3691
Practice Address - Fax:931-779-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD029059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514317Medicaid
TN6040299OtherBCBS
TN103I083327Medicare PIN