Provider Demographics
NPI:1396882205
Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE-REVENUE AND REIMBURSEMEN
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-936-8877
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1211 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0004
Practice Address - Country:US
Practice Address - Phone:615-322-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X, 282N00000X, 282NC2000X, 283Q00000X, 291U00000X, 3416A0800X, 3416L0300X
TN0000000027282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
No283Q00000XHospitalsPsychiatric Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044-0039Medicaid
TN62-0476822OtherTAX ID
TN440039Medicare Oscar/Certification