Basic Information
| Provider Information | |||||||||
| NPI: | 1639709710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HH TENNESSEE VALLEY PAIN CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 GOVERNORS DR SW STE 400 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562657246 | ||||||||
| FaxNumber: | 2562657017 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 GOVERNORS DR SW STE 400 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562657246 | ||||||||
| FaxNumber: | 2562657017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2020 | ||||||||
| LastUpdateDate: | 01/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | POWERS | ||||||||
| AuthorizedOfficialFirstName: | KELLI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2562658818 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 01/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.