Provider Demographics
NPI:1033407952
Name:TREVECCA NAZARENE UNIVERSITY
Entity Type:Organization
Organization Name:TREVECCA NAZARENE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN ASSISTANT PRO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-248-1225
Mailing Address - Street 1:3802 CRYSTAL SPRING LN
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-4174
Mailing Address - Country:US
Mailing Address - Phone:308-672-4408
Mailing Address - Fax:
Practice Address - Street 1:333 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2834
Practice Address - Country:US
Practice Address - Phone:615-248-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)