Provider Demographics
NPI:1679614812
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:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:C.
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:PINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-322-3573
Mailing Address - Street 1:4163 VILLAGE AT VANDERBILT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-8678
Mailing Address - Country:US
Mailing Address - Phone:615-932-2357
Mailing Address - Fax:615-936-6095
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2524
Practice Address - Country:US
Practice Address - Phone:061-532-2500
Practice Address - Fax:615-936-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID NUMBER
TN0773110006Medicare NSC