Provider Demographics
NPI:1225025653
Name:SEQUATCHIE VALLEY UROLOGY, LLC
Entity type:Organization
Organization Name:SEQUATCHIE VALLEY UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:980 HIGHWAY 28
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3699
Mailing Address - Country:US
Mailing Address - Phone:423-942-2555
Mailing Address - Fax:423-942-2005
Practice Address - Street 1:980 HIGHWAY 28
Practice Address - Street 2:SUITE 201
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3695
Practice Address - Country:US
Practice Address - Phone:423-942-2555
Practice Address - Fax:423-942-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729935Medicare ID - Type Unspecified