Provider Demographics
NPI:1417077058
Name:VANGUARD HEALTHCARE ANCILLARY SERVICES, LLC
Entity Type:Organization
Organization Name:VANGUARD HEALTHCARE ANCILLARY SERVICES, LLC
Other - Org Name:TOTAL ANCILLARY SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-250-7100
Mailing Address - Street 1:6 CADILLAC DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 CADILLAC DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5080
Practice Address - Country:US
Practice Address - Phone:615-250-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440513Medicaid
TN1452939Medicaid
MS00440513Medicaid