1073808747 NPI number — ELIZABETH ANN SCOVILLE MD

Table of content: ELIZABETH ANN SCOVILLE MD (NPI 1073808747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073808747 NPI number — ELIZABETH ANN SCOVILLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOVILLE
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073808747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
719 THOMPSON LN STE 30330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37204-4701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-936-2000
Provider Business Mailing Address Fax Number:
615-936-0605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
1660 THE VANDERBILT CLINIC
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-0128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  55742 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q028514 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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