Organization
MOUNTAIN VALLEY RX 05 INC
Active
Other names
JEFFCO DRUG CENTER IN JEFFERSON CITY
Organization subpart
No
Provider details
NPI number
Authorized official
BEAU KISABETH (MANAGER)
(865) 388-3211
Entity
Organization
Contact information
Practice address
153 E BROADWAY BLVD, STE 103, JEFFERSON CITY, TN 37760-2517
(865) 471-5111
(865) 471-5199
Mailing address
PO BOX 385, DANDRIDGE, TN 37725-0385
(865) 475-9969
(865) 475-9901
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3918
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4437364
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/23/2007
Last updated
03/30/2010
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us