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Mountain Valley Rx 05 Inc

Community/Retail Pharmacy in Jefferson City, TN · enumerated 2007 · authorized official Beau Kisabeth, Manager.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1043364490

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Registry record

Entity type Organization (Type 2)
Legal business name Mountain Valley Rx 05 Inc
Other name <Unavail>
Practice address 153 E Broadway Blvd, Ste 103, Jefferson City, TN, 37760
Phone (865) 471-5111
Fax (865) 471-5199
Enumeration date Jan 23, 2007
Last updated in NPPES Mar 30, 2010

Taxonomy & classification

332B00000X Durable Medical Equipment & Medical Supplies Suppliers Secondary
3336C0003X Community/Retail Pharmacy Suppliers · License 3918 (TN) Primary

Authorized official

Name Beau Kisabeth
Title Manager
Phone (865) 388-3211

Other identifiers

Identifier Type State Issuer
4437364 Other - NCPDP PROVIDER IDENTIFICATION NUMBER

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is a Type 2 NPI?
A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.
What type of organization is Mountain Valley Rx 05 Inc?
Mountain Valley Rx 05 Inc is registered in NPPES as a Community/Retail Pharmacy (its primary provider taxonomy).

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2010-03-30.