MEDICARE: TREVECCA NAZARENE UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1033407952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREVECCA NAZARENE UNIVERSITY

Provider Business Mailing Address
First Line	:	3802 CRYSTAL SPRING LN
Second Line	:
City	:	HERMITAGE
State	:	TN
Zip	:	37076-4174
Country	:	US
Telephone Number	:	308-672-4408
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 MURFREESBORO RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-2834
Country	:	US
Telephone Number	:	615-248-1200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PHYSICIAN ASSISTANT PRO
Name	:	DR. MICHAEL MOREDOCK
Credential	:	M.D.
Telephone Number	:	615-248-1225

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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