=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962800912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY HEALTH SYSTEM, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2014
-----------------------------------------------------
Last Update Date | 06/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1930 ALCOA HWY STE 235
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37920-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-305-9030
-----------------------------------------------------
Fax | 865-305-6675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 415000-MSC8149
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37241-8149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-670-6199
-----------------------------------------------------
Fax | 865-670-6198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | BETH A MAYNARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-305-6427
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207SG0201X
-----------------------------------------------------
Taxonomy Name | Clinical Genetics (M.D.) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------