Provider Demographics
NPI:1437101573
Name:TENNESSEE VALLEY SPECIALTY CENTER
Entity Type:Organization
Organization Name:TENNESSEE VALLEY SPECIALTY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FIRYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-363-2925
Mailing Address - Street 1:1275 E COLLEGE ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4500
Mailing Address - Country:US
Mailing Address - Phone:931-363-2925
Mailing Address - Fax:931-363-9563
Practice Address - Street 1:1275 E COLLEGE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4500
Practice Address - Country:US
Practice Address - Phone:931-363-2925
Practice Address - Fax:931-363-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherGROUP TAX ID #
TN=========OtherGROUP TAX ID #