Healthcare Provider Details

I. General information

NPI: 1972771707
Provider Name (Legal Business Name): UNIVITA OF TENNESSEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 DODDS AVE
CHATTANOOGA TN
37407-1628
US

IV. Provider business mailing address

2900 DODDS AVE
CHATTANOOGA TN
37407-1628
US

V. Phone/Fax

Practice location:
  • Phone: 423-757-9400
  • Fax: 723-757-9445
Mailing address:
  • Phone: 423-757-9400
  • Fax: 423-757-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0000000510
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0000000510
License Number StateTN

VIII. Authorized Official

Name: MR. JEFF SJOBECK
Title or Position: VICE PRESIDENT
Credential:
Phone: 952-516-6289