Provider Demographics
NPI:1164850293
Name:TENNESSEE VALLEY REGIONAL LABORATORY
Entity Type:Organization
Organization Name:TENNESSEE VALLEY REGIONAL LABORATORY
Other - Org Name:CRESCENT LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:PART OWNER
Authorized Official - Phone:865-384-8857
Mailing Address - Street 1:930 ADELL REE PARK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2543
Mailing Address - Country:US
Mailing Address - Phone:865-357-2127
Mailing Address - Fax:865-769-2616
Practice Address - Street 1:930 ADELL REE PARK LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2543
Practice Address - Country:US
Practice Address - Phone:865-357-2127
Practice Address - Fax:865-769-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory