Provider Demographics
NPI:1467603399
Name:VCP NASHVILLE, LLC
Entity Type:Organization
Organization Name:VCP NASHVILLE, LLC
Other - Org Name:VEIN CARE PAVILION OF NASHVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-854-3333
Mailing Address - Street 1:447 N BELAIR RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3090
Mailing Address - Country:US
Mailing Address - Phone:706-854-3333
Mailing Address - Fax:706-854-2059
Practice Address - Street 1:278 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5224
Practice Address - Country:US
Practice Address - Phone:615-329-0029
Practice Address - Fax:615-327-8524
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VCP NASHVILLE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-09
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21108208200000X
TN26844208200000X
TN439562086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370314OtherMEDICARE GROUP PTAN