Healthcare Provider Details

I. General information

NPI: 1780829903
Provider Name (Legal Business Name): TENNESEE VALLEY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S G-357
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1310 24TH AVE S G-357
NASHVILLE TN
37212-2637
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4751
  • Fax: 615-321-6337
Mailing address:
  • Phone: 615-327-4751
  • Fax: 615-321-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCFO02573
License Number StateTN

VIII. Authorized Official

Name: JON GREGORY HOUGLUM
Title or Position: ORTHOTIC FITTER
Credential: CFO
Phone: 615-327-4751