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General NPI Number Information
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NPI Number | 1316974231
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Entity Type | Organization
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Legal Business Name | VANDERBILT UNIVERSITY
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 1161 21ST AVE S ROOM 1815 THE VANDERBILT CLINIC
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City | NASHVILLE
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State | TN
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Zip | 37232-0001
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Country | US
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Telephone | 615-322-6480
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Fax | 615-322-4300
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Provider Business Mailing Address
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Address Line | THE VANDERBILT CLINIC ROOM 1815
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City | NASHVILLE
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State | TN
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Zip | 37232-0001
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Country | US
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Telephone | 615-322-6480
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Fax | 615-322-4300
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Authorized Official
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Title or Position | ASST DIRECTOR
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Name | WALT WOODS
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Credential |
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Telephone | 615-322-6480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 1008
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License Number State | TN
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