Provider Demographics
NPI:1720592983
Name:TENNESSEE VALLEY BONE AND JOINT LLC
Entity Type:Organization
Organization Name:TENNESSEE VALLEY BONE AND JOINT LLC
Other - Org Name:TENNESSEE VALLEY BONE AND JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NCPDP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-636-9702
Mailing Address - Street 1:PO BOX 3328
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:479-636-9702
Mailing Address - Fax:877-427-2307
Practice Address - Street 1:2350 N OCOEE STREET
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:479-636-9702
Practice Address - Fax:877-427-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001134332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site