Provider Demographics
NPI:1912994625
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:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:754-777-5321
Mailing Address - Street 1:947 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3753
Mailing Address - Country:US
Mailing Address - Phone:615-650-8000
Mailing Address - Fax:615-724-0242
Practice Address - Street 1:947 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3753
Practice Address - Country:US
Practice Address - Phone:615-650-8000
Practice Address - Fax:615-724-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000510332B00000X, 332BC3200X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45001641Medicaid
TN0103950OtherBLUECROSS BLUESHIELD
GA00727207BMedicaid
TN1452401Medicaid
TN3558151Medicaid
KY90262601Medicaid
VA009109617Medicaid
TN0190190001Medicare NSC
AL009802070Medicaid
VA009109617Medicaid