Healthcare Provider Details

I. General information

NPI: 1467959155
Provider Name (Legal Business Name): JASON VANCE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7586 CATCHFLY DR
OOLTEWAH TN
37363-1725
US

IV. Provider business mailing address

7586 CATCHFLY DR
OOLTEWAH TN
37363-1725
US

V. Phone/Fax

Practice location:
  • Phone: 530-966-5454
  • Fax:
Mailing address:
  • Phone: 530-966-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON VANCE
Title or Position: OWNER
Credential: MD
Phone: 530-966-5454