1700950284 NPI number — VANDERBILT UNIVERSITY MEDICAL CENTER

Table of content: (NPI 1700950284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700950284 NPI number — VANDERBILT UNIVERSITY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANDERBILT UNIVERSITY MEDICAL CENTER
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:
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:
1700950284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2320 BROOKFIELD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-776-7164
Provider Business Mailing Address Fax Number:
615-776-7164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 21ST AVE S
Provider Second Line Business Practice Location Address:
3108 MEDICAL CENTER EAST
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-0014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-9419
Provider Business Practice Location Address Fax Number:
615-936-6493
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOWENS
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT PROFESSOR
Authorized Official Telephone Number:
615-343-9419

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  MD28938 , 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)





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