Provider Demographics
NPI:1053449660
Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Other - Org Name:VANDERBILT DIALYSIS CLINIC - EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE-REVENUE AND REIMBURSEMEN
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:615-936-8875
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 RACHEL DRIVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3609
Practice Address - Country:US
Practice Address - Phone:615-467-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QE0700X
TN0000000146282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44-2654Medicare ID - Type UnspecifiedMEDICARE NUMBER
TN=========OtherTAX ID