Provider Demographics
NPI:1255417598
Name:TENNESSEE VALLEY CARDIOVASCULAR CENTER, PC
Entity type:Organization
Organization Name:TENNESSEE VALLEY CARDIOVASCULAR CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:VARIE
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-766-2118
Mailing Address - Street 1:1120 S JACKSON HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5777
Mailing Address - Country:US
Mailing Address - Phone:256-383-8066
Mailing Address - Fax:256-383-8727
Practice Address - Street 1:1120 S JACKSON HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5777
Practice Address - Country:US
Practice Address - Phone:256-383-8066
Practice Address - Fax:256-383-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23786207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529202460Medicaid