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General NPI Number Information
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NPI Number | 1831158708
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Entity Type | Organization
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Legal Business Name | TENNESSEE VALLEY PEDIATRIC SEDATION SERVICES
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 101 SIVLEY RD SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4421
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Country | US
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Telephone | 256-265-7671
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Fax | 256-265-7670
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Provider Business Mailing Address
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Address Line | 6585 HIGHWAY 431 S
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City | HAMPTON COVE
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State | AL
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Zip | 35763-9230
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Country | US
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Telephone | 256-652-7852
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Fax | 256-265-7670
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIS YNGVE OLSON
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Credential | MD
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Telephone | 256-652-7852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 20602
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License Number State | AL
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