Healthcare Provider Details

I. General information

NPI: 1942359369
Provider Name (Legal Business Name): TENNESSEE VALLEY LUNG CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27669 CAPSHAW RD. A2
HARVEST AL
35749-7403
US

IV. Provider business mailing address

27669 CAPSHAW RD SUITE A2
HARVEST AL
35749-7403
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-0667
  • Fax: 256-232-0557
Mailing address:
  • Phone: 256-232-0667
  • Fax: 256-232-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16579
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16579
License Number StateAL

VIII. Authorized Official

Name: DR. WILLIAM P THOMAS
Title or Position: PRESIDENT
Credential: MD
Phone: 256-232-0667