=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770959017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENNESSEE VALLEY HEALTH CARE SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2015
-----------------------------------------------------
Last Update Date | 08/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 POINT WEST CV
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-3371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-685-0913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 POINT WEST CV
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-3371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASST CHIEF OF PSYCHOLOGY
-----------------------------------------------------
Name | DR. ERIN PATEL
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 615-225-3782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------