Healthcare Provider Details

I. General information

NPI: 1285091330
Provider Name (Legal Business Name): VANDERBILT UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 MEDICAL CENTER DR TVC 1815
NASHVILLE TN
37232-0004
US

IV. Provider business mailing address

726 MELROSE AVE
NASHVILLE TN
37211-2151
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-6480
  • Fax: 615-329-9358
Mailing address:
  • Phone: 615-322-6480
  • Fax: 615-329-9358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH30942
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1008
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1190
License Number StateNE
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number111952
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2017035590
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number16229
License Number StateMS
# 8
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberTN2111
License Number StateKY
# 9
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHNR001329
License Number StateGA

VIII. Authorized Official

Name: MARK SULLIVAN
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 615-343-9595