Basic Information
Provider Information
NPI: 1588198949
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VASS
FirstName: CALEB
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2000 HEALTH PARK DR FL HP2
Address2:  
City: BRENTWOOD
State: TN
PostalCode: 370274525
CountryCode: US
TelephoneNumber: 6153727600
FaxNumber:  
Practice Location
Address1: 4550 LEE HWY STE B
Address2:  
City: DUBLIN
State: VA
PostalCode: 240843802
CountryCode: US
TelephoneNumber: 5406744560
FaxNumber: 5406744713
Other Information
ProviderEnumerationDate: 04/12/2017
LastUpdateDate: 06/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X0102206156VAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home