Provider Demographics
NPI:1780829903
Name:TENNESEE VALLEY HEALTH CARE
Entity type:Organization
Organization Name:TENNESEE VALLEY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIC FITTER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:HOUGLUM
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:615-327-4751
Mailing Address - Street 1:1310 24TH AVE S
Mailing Address - Street 2:G-357
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2637
Mailing Address - Country:US
Mailing Address - Phone:615-327-4751
Mailing Address - Fax:615-321-6337
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:G-357
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-327-4751
Practice Address - Fax:615-321-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCFO02573335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier