MEDICARE: VANDERBILT MEDICAL CENTER

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	282NC2000X	Children's Hospital	078178	TN

General Provider Information

NPI Number	:	1164609319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDERBILT MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2200 CHILDRENS WAY
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 CHILDRENS WAY
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0034
Country	:	US
Telephone Number	:	615-936-0027
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	MRS. DEANA VANDIVIER
Credential	:
Telephone Number	:	615-936-0027

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	02/08/2008

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Directions to “VANDERBILT MEDICAL CENTER ” Practice Location

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