Provider Demographics
NPI:1710185921
Name:UNIVERSITY HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH SYSTEM, INC
Other - Org Name:KEITH D GRAY MD SURGICAL ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARQUART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-305-9886
Mailing Address - Street 1:PO BOX 440251
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0251
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6158
Practice Address - Street 1:1926 ALCOA HWY
Practice Address - Street 2:STE 410
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1512
Practice Address - Country:US
Practice Address - Phone:865-544-9218
Practice Address - Fax:865-305-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1504277Medicaid
TN32851412Medicare PIN