Healthcare Provider Details

I. General information

NPI: 1164850293
Provider Name (Legal Business Name): TENNESSEE VALLEY REGIONAL LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 ADELL REE PARK LN
KNOXVILLE TN
37909-2543
US

IV. Provider business mailing address

930 ADELL REE PARK LN
KNOXVILLE TN
37909-2543
US

V. Phone/Fax

Practice location:
  • Phone: 865-357-2127
  • Fax: 865-769-2616
Mailing address:
  • Phone: 865-357-2127
  • Fax: 865-769-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number00
License Number StateTN

VIII. Authorized Official

Name: LUCY L SPURGEON
Title or Position: PART OWNER
Credential: PART OWNER
Phone: 865-384-8857