Provider Demographics
NPI:1528150596
Name:RENE C DEL VALLE MD PLLC
Entity type:Organization
Organization Name:RENE C DEL VALLE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-450-5062
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37111-0389
Mailing Address - Country:US
Mailing Address - Phone:931-450-5062
Mailing Address - Fax:931-450-5063
Practice Address - Street 1:1615 MCMINNVILLE HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3179
Practice Address - Country:US
Practice Address - Phone:931-450-5062
Practice Address - Fax:931-450-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD017200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3706110Medicaid
TN7440419OtherUNITED HEALTHCARE
TN0202322OtherBCBS
TN3706110Medicaid