Provider Demographics
NPI:1073608139
Name:VANDERBILT UNIV. MEDICAL CENTER
Entity Type:Organization
Organization Name:VANDERBILT UNIV. MEDICAL CENTER
Other - Org Name:TVHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:615-327-4751
Mailing Address - Street 1:2773 CALL HILL RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6871
Mailing Address - Country:US
Mailing Address - Phone:615-833-2606
Mailing Address - Fax:
Practice Address - Street 1:777 PRB
Practice Address - Street 2:2220 PIERCE AV.
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-327-4751
Practice Address - Fax:615-321-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30481282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG79963Medicare UPIN