Provider Demographics
NPI:1154666451
Name:THE VACCINATION CLINIC, PC
Entity Type:Organization
Organization Name:THE VACCINATION CLINIC, PC
Other - Org Name:SHOTS, ETC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:J
Authorized Official - Last Name:IVANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:615-525-7618
Mailing Address - Street 1:7648 HIGHWAY 70 S
Mailing Address - Street 2:SUITE 15
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1742
Mailing Address - Country:US
Mailing Address - Phone:615-469-7413
Mailing Address - Fax:615-469-5935
Practice Address - Street 1:7648 HIGHWAY 70 S
Practice Address - Street 2:SUITE 15
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1742
Practice Address - Country:US
Practice Address - Phone:615-469-7413
Practice Address - Fax:615-469-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health