MEDICARE: JASON VANCE MD A MEDICAL CORPORATION

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1679402267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON VANCE MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2137 HEAVENLY VW
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-9488
Country	:	US
Telephone Number	:	530-966-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	2137 HEAVENLY VW
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-9488
Country	:	US
Telephone Number	:	530-966-5454
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASON VANCE
Credential	:	MD
Telephone Number	:	530-966-5454

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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