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General NPI Number Information
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NPI Number | 1881605509
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Entity Type | Organization
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Legal Business Name | TENNESSEE VALLEY UROLOGY PC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 103 STATION DRIVE BUILDING 4
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City | MARYVILLE
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State | TN
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Zip | 37804-4190
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Country | US
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Telephone | 865-982-7540
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Fax | 865-981-1682
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Provider Business Mailing Address
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Address Line | 103 STATION DRIVE BUILDING 4
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City | MARYVILLE
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State | TN
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Zip | 37804-4190
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Country | US
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Telephone | 865-982-7540
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Fax | 865-981-1682
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN R MYNATT
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Credential | M.D.
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Telephone | 865-982-7540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MC0000012896
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 012896
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License Number State | TN
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