MEDICARE: TENNESSEE VALLEY HEALTHCARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2865M2000X	Military General Acute Care Hospital	13572	TN

General Provider Information

NPI Number	:	1902062425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE VALLEY HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	1310 24TH AVE S # 11T
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:	615-321-6373
Fax Number	:	615-321-6374

Provider Business Practice Location Address
First Line	:	1310 24TH AVE S # 11T
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:	615-321-6373
Fax Number	:	615-321-6374

Authorized Official
Title or Position	:	DIRECTOR STEM CELL TRANSPLANT
Name	:	DR. STACEY GOODMAN
Credential	:	MD
Telephone Number	:	615-321-6373

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/04/2008

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