MEDICARE: UNIVITA OF TENNESSEE, INC.

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	332BX2000X	Oxygen Equipment & Supplies (DME)	510	TN

General Provider Information

NPI Number	:	1295071314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVITA OF TENNESSEE, INC.

Provider Business Mailing Address
First Line	:	947 WOODLAND ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3753
Country	:	US
Telephone Number	:	615-650-8000
Fax Number	:	615-724-0242

Provider Business Practice Location Address
First Line	:	1572 S MAPLE AVE
Second Line	:	SUITE A
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-2605
Country	:	US
Telephone Number	:	615-650-8000
Fax Number	:	615-724-0242

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JEFF SJOBECK
Credential	:
Telephone Number	:	952-516-6289

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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