=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528150596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENE C DEL VALLE MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 03/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 MCMINNVILLE HWY
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37355-3179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-450-5062
-----------------------------------------------------
Fax | 931-450-5063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 389
-----------------------------------------------------
City | MCMINNVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37111-0389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-450-5062
-----------------------------------------------------
Fax | 931-450-5063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER MD
-----------------------------------------------------
Name | DR. RENE C DEL VALLE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 931-450-5062
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD017200
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------