Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mountain Valley Rx 05 Inc

Organization Durable Medical Equipment & Medical Supplies · NPI 1043364490

Mountain Valley Rx 05 Inc is a Durable Medical Equipment & Medical Supplies in Jefferson City, Tennessee. Licensed in Tennessee. Registered with an NPI since 2007.

Licensed in
TN
In the registry since
2007
Specialties on file
2
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

153 E Broadway Blvd Ste 103
Jefferson City, TN 37760-2517
Phone: (865) 471-5111
Fax: (865) 471-5199
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X · Licence 3918 (TN)
Durable Medical Equipment & Medical Supplies Taxonomy 332B00000X

Record details

NPI number1043364490
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Beau Kisabeth — Manager · (865) 388-3211
Other names Jeffco Drug Center In Jefferson City
NPI enumeratedJanuary 23, 2007
Last updated in NPPESMarch 30, 2010
Mailing addressPo Box 385, Dandridge, TN 37725-0385

Other providers in Jefferson City