Healthcare Provider Details

I. General information

NPI: 1689790628
Provider Name (Legal Business Name): TENNESSEE VALLEY PEDIATRIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LOWELL DR SE SUITE 401
HUNTSVILLE AL
35801-3754
US

IV. Provider business mailing address

420 LOWELL DR SE SUITE 401
HUNTSVILLE AL
35801-3754
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-1800
  • Fax: 256-265-1801
Mailing address:
  • Phone: 256-801-6036
  • Fax: 256-801-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLI S POWERS
Title or Position: CFO
Credential:
Phone: 256-265-8818