Provider Demographics
NPI:1356448633
Name:TN VALLEY
Entity Type:Organization
Organization Name:TN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:REXFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBENOHEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-525-1651
Mailing Address - Street 1:PO BOX 3432
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38502-3432
Mailing Address - Country:US
Mailing Address - Phone:931-525-1651
Mailing Address - Fax:931-525-1653
Practice Address - Street 1:1101 NEAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0901
Practice Address - Country:US
Practice Address - Phone:931-525-1651
Practice Address - Fax:931-525-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000046089261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA