Basic Information
| Provider Information | |||||||||
| NPI: | 1780829903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESEE VALLEY HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1310 24TH AVE S | ||||||||
| Address2: | G-357 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372122637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153274751 | ||||||||
| FaxNumber: | 6153216337 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 24TH AVE S | ||||||||
| Address2: | G-357 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372122637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153274751 | ||||||||
| FaxNumber: | 6153216337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2008 | ||||||||
| LastUpdateDate: | 12/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOUGLUM | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
| AuthorizedOfficialMiddleName: | GREGORY | ||||||||
| AuthorizedOfficialTitleorPosition: | ORTHOTIC FITTER | ||||||||
| AuthorizedOfficialTelephone: | 6153274751 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | CFO02573 | TN | Y | Suppliers | Prosthetic/Orthotic Supplier |
No ID Information.