Provider Demographics
NPI:1851419469
Name:UNIVITA OF TENNESSEE, INC.
Entity Type:Organization
Organization Name:UNIVITA OF TENNESSEE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRYD
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:754-777-5321
Mailing Address - Street 1:3716 E STONE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7112
Mailing Address - Country:US
Mailing Address - Phone:423-392-9900
Mailing Address - Fax:423-392-9922
Practice Address - Street 1:3716 E STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7112
Practice Address - Country:US
Practice Address - Phone:423-392-9900
Practice Address - Fax:423-392-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000510332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0190190003Medicare NSC