| Valor Medical Llc | |
|
152 Market Place Blvd Bldg F Knoxville TN 37922-2337 | |
| (865) 212-2211 | |
| (833) 314-0589 |
| Full Name | Valor Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 152 Market Place Blvd Bldg F, Knoxville, Tennessee |
| Authorized Official Name and Position | Susan T Hicks (OWNER, NURSE PRACTITIONER) |
| Authorized Official Contact | 8652122211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valor Medical Llc 140 Market Place Blvd Ste E Knoxville TN 37922-2337 Ph: (865) 212-2211 | Valor Medical Llc 152 Market Place Blvd Bldg F Knoxville TN 37922-2337 Ph: (865) 212-2211 |
| NPI Number | 1659716934 |
|---|---|
| Provider Enumeration Date | 05/01/2013 |
| Last Update Date | 06/04/2024 |
| Certification Date | 06/04/2024 |
| Medicare PECOS PAC ID | 2668607680 |
|---|---|
| Medicare Enrollment ID | O20131029001636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659716934 | NPI | - | NPPES |
| 1533218 | Medicaid | TN |
| Provider Name | Jairo A Fortich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104867381 PECOS PAC ID: 9638100282 Enrollment ID: I20060413000624 |
| Provider Name | Susan T Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477938660 PECOS PAC ID: 5698082279 Enrollment ID: I20150915000436 |
| Provider Name | David Neal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578612156 PECOS PAC ID: 8426306275 Enrollment ID: I20180809006296 |
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