NPIMap

Organization Active NPI

Tennessee Valley Healthcare LLC

Doing business as Hazel Green Pharmacy

  • Community/Retail Pharmacy
  • Hazel Green, AL
National Provider Identifier
1104856459
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
112435 Issued in AL
Legal business name
TENNESSEE VALLEY HEALTHCARE LLC
Doing business as
Hazel Green Pharmacy
Practice address
13574 Highway 231 431 N Ste B
Hazel Green, AL 35750-8642
Phone
(256) 813-0150
Fax
(256) 813-0149
NPI assigned
Jul 3, 2006
Last updated
Feb 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Chandler Thomas Willingham, RPH
Title
Co-Owner/Pharmacist
Phone
(256) 813-0150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 112435 AL Primary

Addresses

Primary practice location

13574 Highway 231 431 N Ste B
Hazel Green, AL 35750-8642

Mailing address

13574 Highway 231 431 N Ste B
Hazel Green, AL 35750-8642
Phone (256) 813-0150

Other names 1

  • Hazel Green Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930017951 AL DME Supplier - Pharmacy 2961619770 Practice locations: Hazel Green, AL
O20151102001153 AL Part B Supplier - Mass Immunization (Roster Biller Only) 2961619770 Practice locations: Hazel Green, AL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Tennessee Valley Healthcare LLC13574 Highway 231 431 N, Hazel Green, AL 35750-8642(256) 813-0150 Immunosuppressive Drugs|Nebulizer Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches Accepts assignmentParticipating since Jun 28, 2003

National Provider Directory

National Provider Directory
Tax ID family
Hazel Green Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13574 Highway 231 431 N
#B
Hazel Green, AL 35750
Phone (256) 813-0150

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1104856459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13574 HIGHWAY 231 431 N STE B",
            "city": "HAZEL GREEN",
            "state": "AL",
            "postal_code": "357508642",
            "telephone_number": "256-813-0150",
            "fax_number": "256-813-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13574 HIGHWAY 231 431 N STE B",
            "city": "HAZEL GREEN",
            "state": "AL",
            "postal_code": "357508642",
            "telephone_number": "256-813-0150",
            "fax_number": "256-813-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE VALLEY HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2015-02-24",
        "status": "A",
        "authorized_official_last_name": "WILLINGHAM",
        "authorized_official_first_name": "CHANDLER",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CO-OWNER/PHARMACIST",
        "authorized_official_telephone_number": "256-813-0150",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "112435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazel Green Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazel Green, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.