Provider Demographics
NPI:1023131281
Name:WYCHE & WYCHE, M.D., P.C.
Entity type:Organization
Organization Name:WYCHE & WYCHE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WYCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-282-2542
Mailing Address - Street 1:2406 SUSANNAH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1725
Mailing Address - Country:US
Mailing Address - Phone:423-282-2542
Mailing Address - Fax:423-282-5447
Practice Address - Street 1:2406 SUSANNAH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1725
Practice Address - Country:US
Practice Address - Phone:423-282-2542
Practice Address - Fax:423-282-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3384370Medicare ID - Type Unspecified