Healthcare Provider Details

I. General information

NPI: 1902062425
Provider Name (Legal Business Name): TENNESSEE VALLEY HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S # 11T
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1310 24TH AVE S # 11T
NASHVILLE TN
37212-2637
US

V. Phone/Fax

Practice location:
  • Phone: 615-321-6373
  • Fax: 615-321-6374
Mailing address:
  • Phone: 615-321-6373
  • Fax: 615-321-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number13572
License Number StateTN

VIII. Authorized Official

Name: DR. STACEY GOODMAN
Title or Position: DIRECTOR STEM CELL TRANSPLANT
Credential: MD
Phone: 615-321-6373