=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154693687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VANDERBILT MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2012
-----------------------------------------------------
Last Update Date | 01/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 OXFORD HOUSE 1313 21ST AVE SOUTH
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37232-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-936-3500
-----------------------------------------------------
Fax | 615-936-3829
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 908 OXFORD HOUSE 1313 21ST AVE SOUTH
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37232-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-936-3500
-----------------------------------------------------
Fax | 615-936-3829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT ADMINISTRATIVE DIRECTOR
-----------------------------------------------------
Name | MRS. JERITA PAYNE
-----------------------------------------------------
Credential | ACNP-BC
-----------------------------------------------------
Telephone | 615-936-0431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | APN0000016324
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------