Provider Demographics
NPI:1881605509
Name:TENNESSEE VALLEY UROLOGY PC
Entity type:Organization
Organization Name:TENNESSEE VALLEY UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYNATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-982-7540
Mailing Address - Street 1:103 STATION DRIVE
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-4190
Mailing Address - Country:US
Mailing Address - Phone:865-982-7540
Mailing Address - Fax:865-981-1682
Practice Address - Street 1:103 STATION DRIVE
Practice Address - Street 2:BUILDING 4
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-4190
Practice Address - Country:US
Practice Address - Phone:865-982-7540
Practice Address - Fax:865-981-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMC0000012896208800000X
TN012896208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98279Medicare UPIN
0049Medicare PIN
NC3019014Medicare PIN