MEDICARE: DR. JASON R VANCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	65025	TN
2	207QA0505X	Adult Medicine Physician	44928	AL
3	207Q00000X	Family Medicine Physician	A60594	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44928	OTHER	AL	AL LICENSE
2	ZZZ01920Z	OTHER	CA	BLUE SHIELD
3	65025	OTHER	TN	TN LICENSE

General Provider Information

NPI Number	:	1912938234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON R VANCE M.D.

Provider Business Mailing Address
First Line	:	2137 HEAVENLY VW
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-9488
Country	:	US
Telephone Number	:	530-966-5454
Fax Number	:	530-872-6653

Provider Business Practice Location Address
First Line	:	2137 HEAVENLY VW
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-9488
Country	:	US
Telephone Number	:	530-966-5454
Fax Number	:	530-872-6653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/10/2026

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Directions to “ DR. JASON R VANCE M.D.” Practice Location

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