Healthcare Provider Details

I. General information

NPI: 1528579604
Provider Name (Legal Business Name): VALLEY EMERGENCY PHYSICIANS TENNESSEE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 DUNLOP LN
CLARKSVILLE TN
37040-5015
US

IV. Provider business mailing address

PO BOX 9246
DAYTONA BEACH FL
32120-9246
US

V. Phone/Fax

Practice location:
  • Phone: 931-502-1000
  • Fax: 386-274-7801
Mailing address:
  • Phone: 386-274-7800
  • Fax: 386-274-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEVE P MARON
Title or Position: PRESIDENT
Credential: MD
Phone: 626-447-0296