MEDICARE: UNIVITA OF TENNESSEE, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	0000000510	TN
2	332BX2000X	Oxygen Equipment & Supplies (DME)	0000000510	TN
3	332BC3200X	Customized Equipment (DME)	0000000510	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0103950	OTHER	TN	BLUECROSS BLUESHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912994625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVITA OF TENNESSEE, INC.

Provider Business Mailing Address
First Line	:	947 WOODLAND ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3753
Country	:	US
Telephone Number	:	615-650-8000
Fax Number	:	615-724-0242

Provider Business Practice Location Address
First Line	:	947 WOODLAND ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3753
Country	:	US
Telephone Number	:	615-650-8000
Fax Number	:	615-724-0242

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	MR. DOUGLAS D BYRD
Credential	:	ESQ
Telephone Number	:	754-777-5321

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	05/12/2015

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