Provider Demographics
NPI:1427134147
Name:SEQUATCHIE VALLEY UROLOGY LLC
Entity type:Organization
Organization Name:SEQUATCHIE VALLEY UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-837-3334
Mailing Address - Street 1:1000 HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3638
Mailing Address - Country:US
Mailing Address - Phone:423-837-9500
Mailing Address - Fax:423-837-3333
Practice Address - Street 1:1000 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3638
Practice Address - Country:US
Practice Address - Phone:423-837-9500
Practice Address - Fax:423-837-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729935Medicare ID - Type UnspecifiedMEDICARE PART B