Tennessee Valley Healthcare LLC
Organization Active NPI Community/Retail Pharmacy · Hazel Green, AL
NPI 1104856459 · NPPES record last updated Feb 24, 2015
Key facts
- NPI
- 1104856459
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 112435 (AL)
- Legal business name
- TENNESSEE VALLEY HEALTHCARE LLC
- 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Chandler Thomas Willingham, RPH
- Title
- Co-Owner/Pharmacist
- Phone
- (256) 813-0150
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 4
-
Joshua Campbell, PHARM.D.
-
Micheal Alan Powers, RPH
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Tennessee Valley Healthcare LLC |
Immunosuppressive Drugs|Nebulizer Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Hazel Green Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 112435 | AL | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009996955 | Medicaid | AL | |
| 100003533 | Medicaid | AL |
Other names
- Hazel Green Pharmacy
Other providers in Hazel Green, AL
- St'S Touched Expressions
- Adriana Stegall
- Daniel Jackson Stuart
- Laura Lee Taylor
- Tennessee Brace and Medical Services LLC
- The Drug Store at Griners LLC
- Therafit, LLC
- Anna Lauren Underwood
- Urgent Care Northwest PC
- Wal-Mart Stores East LP
All providers in Hazel Green, AL · Community/Retail Pharmacy in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.