1083923197 NPI number — UNIVERSITY HEALTH SYSTEM, INC

Table of content: (NPI 1083923197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083923197 NPI number — UNIVERSITY HEALTH SYSTEM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY HEALTH SYSTEM, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UT INTERNAL MEDICINE JEFFERSON CITY
Provider Other Organization Name Type Code:
3
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:
1083923197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 440476
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:
37244-0476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-670-6199
Provider Business Mailing Address Fax Number:
865-670-6188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1413 RUSSELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37760-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-670-6199
Provider Business Practice Location Address Fax Number:
865-670-6188
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MARQUART
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
865-305-9886

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , 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: 1521415 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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