Provider Demographics
NPI:1639151582
Name:PAULA VASSAR INC
Entity Type:Organization
Organization Name:PAULA VASSAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:H
Authorized Official - Last Name:VASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-885-6600
Mailing Address - Street 1:1720 E. REELFOOT AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6048
Mailing Address - Country:US
Mailing Address - Phone:731-885-6600
Mailing Address - Fax:731-885-9239
Practice Address - Street 1:1720 E. REELFOOT AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6048
Practice Address - Country:US
Practice Address - Phone:731-885-6600
Practice Address - Fax:731-885-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2023-12-05
Deactivation Date:2007-08-14
Deactivation Code:
Reactivation Date:2007-08-22
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
TNRN0000041618363LF0000X
TNAPN00005325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3160475OtherBCBS
TN3343233Medicaid
7937258OtherAETNA
TN3343233Medicaid
TN3160475OtherBCBS
7937258OtherAETNA