1720255532 NPI number — VCP NASHVILLE, LLC

Table of content: (NPI 1720255532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720255532 NPI number — VCP NASHVILLE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VCP NASHVILLE, LLC
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:
6
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:
1720255532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4350 TOWNE CENTRE DR
Provider Second Line Business Mailing Address:
STE 2000
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30809-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-854-3333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 STATE ST
Provider Second Line Business Practice Location Address:
STE 200B-1
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-329-0029
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROTH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SOLE MEMBER/PRESIDENT
Authorized Official Telephone Number:
706-854-3333

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  26844 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: 21108 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 43956 , 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: 3370314 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".