Provider Demographics
NPI:1538696802
Name:TENNESSEE VALLEY NEUROLOGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:TENNESSEE VALLEY NEUROLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODROS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENGESHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-265-2695
Mailing Address - Street 1:201 SIVLEY RD SW STE 540
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5138
Mailing Address - Country:US
Mailing Address - Phone:256-265-2695
Mailing Address - Fax:256-265-6386
Practice Address - Street 1:201 SIVLEY RD SW STE 540
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5138
Practice Address - Country:US
Practice Address - Phone:256-265-2695
Practice Address - Fax:256-265-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty