=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700950284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VANDERBILT UNIVERSITY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 21ST AVE S 3108 MEDICAL CENTER EAST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37232-0014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-343-9419
-----------------------------------------------------
Fax | 615-936-6493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2320 BROOKFIELD DR
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-776-7164
-----------------------------------------------------
Fax | 615-776-7164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT PROFESSOR
-----------------------------------------------------
Name | DR. CLIFFORD BOWENS JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 615-343-9419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | MD28938
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------