Provider Demographics
NPI:1972637411
Name:UNIVERSITY OF TENNESSEE
Entity Type:Organization
Organization Name:UNIVERSITY OF TENNESSEE
Other - Org Name:UNIVERSITY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MURTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-534-7750
Mailing Address - Street 1:910 MADISON AVE STE 922
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3483
Mailing Address - Country:US
Mailing Address - Phone:901-448-5630
Mailing Address - Fax:901-448-7255
Practice Address - Street 1:910 MADISON AVE STE 922
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3483
Practice Address - Country:US
Practice Address - Phone:901-448-5630
Practice Address - Fax:901-448-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373444Medicare PIN
AR5F088Medicare PIN