Provider Demographics
NPI:1578646006
Name:VANDERBILT ASTHMA SINUS ALLERGY PROGRAM
Entity Type:Organization
Organization Name:VANDERBILT ASTHMA SINUS ALLERGY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROVIDER SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KAE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-936-0471
Mailing Address - Street 1:2611 WEST END AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6013
Mailing Address - Country:US
Mailing Address - Phone:615-936-5738
Mailing Address - Fax:615-936-5862
Practice Address - Street 1:2611 WEST END AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-6013
Practice Address - Country:US
Practice Address - Phone:615-936-5738
Practice Address - Fax:615-936-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherGROUP TAX ID