Healthcare Provider Details

I. General information

NPI: 1891002523
Provider Name (Legal Business Name): UNIVERSITY HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ALCOA HWY STE E120
KNOXVILLE TN
37920
US

IV. Provider business mailing address

PO BOX 415000-MSC8139
NASHVILLE TN
37241-8139
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9421
  • Fax: 865-305-6958
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: BETH A. MAYNARD
Title or Position: VICE PRESIDENT
Credential:
Phone: 865-305-6427