MEDICARE: TENNESSEE VALLEY HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	112435	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104856459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE VALLEY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	13574 HIGHWAY 231 431 N STE B
Second Line	:
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8642
Country	:	US
Telephone Number	:	256-813-0150
Fax Number	:	256-813-0149

Provider Business Practice Location Address
First Line	:	13574 HIGHWAY 231 431 N STE B
Second Line	:
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8642
Country	:	US
Telephone Number	:	256-813-0150
Fax Number	:	256-813-0149

Authorized Official
Title or Position	:	CO-OWNER/PHARMACIST
Name	:	MR. CHANDLER THOMAS WILLINGHAM
Credential	:	RPH
Telephone Number	:	256-813-0150

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	02/24/2015

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Directions to “TENNESSEE VALLEY HEALTHCARE LLC ” Practice Location

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