Provider Demographics
| NPI: | 1821637489 |
|---|---|
| Name: | UNIVERSITY HEALTH SYSTEM INC |
| Entity Type: | Organization |
| Organization Name: | UNIVERSITY HEALTH SYSTEM INC |
| Other - Org Name: | UNIVERSITY CARDIOLOGY |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | VICE PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BETH |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | MAYNARD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 865-305-6427 |
| Mailing Address - Street 1: | PO BOX 415000-MSC8179 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | NASHVILLE |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 37241-8179 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 865-670-6199 |
| Mailing Address - Fax: | 865-670-6198 |
| Practice Address - Street 1: | 1940 ALCOA HWY STE E310 |
| Practice Address - Street 2: | |
| Practice Address - City: | KNOXVILLE |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 37920-2267 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 865-544-2800 |
| Practice Address - Fax: | 865-544-6812 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-12-31 |
| Last Update Date: | 2021-03-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Single Specialty |
| No | 207RA0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Advanced Heart Failure and Transplant Cardiology | Group - Single Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Single Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Single Specialty |
| No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Single Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Single Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Single Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Single Specialty |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Single Specialty |
| No | 363LC0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | Group - Single Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |
| No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Single Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TN | Q054431 | Medicaid |
