Individual ProviderJeffrey VaughnFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address2033 Meadowview Ln, 3rd Floor, Kingsport, TN 37660-7569(423) 857-2793(423) 857-2066PECOS EnrollmentBased on the most recent information from CMS, provider Jeffrey Vaughn is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 4:18 PM.Profile DetailsProvider ID1134121320Provider TypeIndividualFull NameVaughn, JeffreyTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date6/1/2005Last Updated5/15/2014Contact InformationPractice LocationPractice Address2033 Meadowview Ln, 3rd Floor, Kingsport, TN 37660-7569Phone(423) 857-2793Fax(423) 578-8025Mailing LocationMailing AddressPO Box 9, Kingsport, TN 37662-0009Phone(423) 857-2066Fax(423) 857-2070Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense18226TennesseeCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense0101041214VirginiaProvider IdentifiersIDDescriptionIssuerID3345605DescriptionMedicaidIssuerUnlistedTennesseeID005613612DescriptionMedicaidIssuerUnlistedVirginiaID3033474DescriptionMedicaidIssuerUnlistedTennesseeID5613612DescriptionMedicaidIssuerUnlistedVirginia