Basic Information
| Provider Information | |||||||||
| NPI: | 1538164090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY HEALTH SYSTEM, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY OF TENNESSEE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 440164 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372440164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652514419 | ||||||||
| FaxNumber: | 8652514406 | ||||||||
| Practice Location | |||||||||
| Address1: | 1924 ALCOA HWY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655449000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 06/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | LANDSMAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8655449430 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 156 | TN | N | Agencies | Home Health | 251G00000X | 389 | TN | N | Agencies | Hospice Care, Community Based | 3416A0800X | EMS0000009903 | TN | N | Transportation Services | Ambulance | Air Transport | 282N00000X | 0000000046 | TN | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 092592600 | 05 | FL | MEDICAID | 3285143 | 01 | TN | CARDIOLOGIST II | OTHER | 01600055 | 05 | KY | MEDICAID | 4406611 | 05 | NC | MEDICAID | UNI0015N | 05 | AL | MEDICAID | 06593456 | 05 | OH | MEDICAID | 626001636001 | 05 | IL | MEDICAID | 000105366A | 05 | GA | MEDICAID | 02283343 | 05 | MS | MEDICAID | 139838105 | 05 | AK | MEDICAID | 00440015 | 05 | TN | MEDICAID | 004400160 | 05 | VA | MEDICAID | 10144A | 05 | SC | MEDICAID | 3285141 | 01 | TN | CARDIOLOGIST | OTHER | 4400015 | 05 | NC | MEDICAID | 55000145 | 05 | KY | MEDICAID |