1912994625 NPI number — UNIVITA OF TENNESSEE, INC.

Table of content: (NPI 1912994625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912994625 NPI number — UNIVITA OF TENNESSEE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVITA OF TENNESSEE, 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:
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:
1912994625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
947 WOODLAND ST
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:
37206-3753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-650-8000
Provider Business Mailing Address Fax Number:
615-724-0242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
947 WOODLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37206-3753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-650-8000
Provider Business Practice Location Address Fax Number:
615-724-0242
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
754-777-5321

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000510 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 0000000510 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 0000000510 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 45001641 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0103950 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00727207B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1452401 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3558151 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90262601 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009109617 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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