Provider Demographics
NPI: | 1952356065 |
---|---|
Name: | VANDERBILT UNIVERSITY |
Entity Type: | Organization |
Organization Name: | VANDERBILT UNIVERSITY |
Other - Org Name: | VANDERBILT MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR, VMG BUSINESS OFFICE |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BRYON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PICKARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-936-2000 |
Mailing Address - Street 1: | 719 THOMPSON LANE |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37232 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-936-2000 |
Mailing Address - Fax: | 615-936-0605 |
Practice Address - Street 1: | 3601 THE VANDERBILT CLINIC |
Practice Address - Street 2: | |
Practice Address - City: | NASHVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37232-5100 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-322-3000 |
Practice Address - Fax: | 615-936-0605 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | VANDERBILT UNIVERSITY |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-05-24 |
Last Update Date: | 2015-12-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | Group - Multi-Specialty | |
No | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3284867 | Medicare PIN | |
TN | 3284867 | Medicare ID - Type Unspecified | CAMPUS GROUP MEDICARE # |