Provider Demographics
NPI:1285091330
Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:VANDERBILT UNIVERSITY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-343-9595
Mailing Address - Street 1:726 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2151
Mailing Address - Country:US
Mailing Address - Phone:615-322-6480
Mailing Address - Fax:615-329-9358
Practice Address - Street 1:1211 MEDICAL CENTER DR
Practice Address - Street 2:TVC 1815
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0004
Practice Address - Country:US
Practice Address - Phone:615-322-6480
Practice Address - Fax:615-329-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH30942333600000X
TN10083336C0003X
NE11903336C0003X
AL1119523336C0003X
MO20170355903336C0003X
MS162293336C0003X
KYTN21113336C0003X
GAPHNR0013293336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157740OtherPK
TNQ026266Medicaid
KY54008081Medicaid
2157740OtherPK
TN7498320002Medicare NSC