Provider Demographics
NPI:1215016522
Name:VANDERBILT UNIVERSITY
Entity Type:Organization
Organization Name:VANDERBILT UNIVERSITY
Other - Org Name:VANDERBILT MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PROVIDER SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MIDGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-936-0471
Mailing Address - Street 1:2146 BELCOURT AVENUE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-8792
Mailing Address - Country:US
Mailing Address - Phone:615-936-6046
Mailing Address - Fax:615-936-6095
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332900000X, 332B00000X, 332H00000X
TN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332H00000XSuppliersEyewear Supplier
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherGROUP TAX ID