Basic Information
| Provider Information | |||||||||
| NPI: | 1881031953 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE VALLEY FAMILY MEDICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26642 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357397624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564238744 | ||||||||
| FaxNumber: | 2562169652 | ||||||||
| Practice Location | |||||||||
| Address1: | 26642 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357397624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564238744 | ||||||||
| FaxNumber: | 2562169652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2013 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | COMER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/COO | ||||||||
| AuthorizedOfficialTelephone: | 2562339172 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.