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DSH440039G Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic (Active)
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Main Details
Name
Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
Subdivision Name
THE VANDERBILT CLINIC - ONE HUNDRED OAKS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440039G
Medicare Provider Number
440039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/1/2009
Participating Start Date
4/1/2009
Participating Approval Date
3/5/2009
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Vanderbilt University Medical Center
James Edgar Newman, Vice President
(615) 293-3406
Primary Contact
DSH440039
Thomas Mark Sullivan, Chief Pharmacy Officer
(615) 343-9595
Addresses
Street Address
719 THOMPSON LANE
SUITE 24131
NASHVILLE, TN 37204
Billing Address
VANDERBILT UNIVERSITY HOSPITAL AND CLINIC
726 MELROSE AVE
NASHVILLE, TN 37211-2151
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/10/12 UPDATED ENTITY NAME (WAS VANDERBILT UNIVERSITY MEDICAL CENTER), UPDATED SUBDIV NAME (WAS VANDERBILT HEALTH), ADDED SHIP ADD, REVISED MEDICAID # (WAS 4442000), ADDED NPI #; 9/30/11 ADDED BILL-TO ADD
04/10/2012
9/30/11 ADDED BILL-TO ADD
09/30/2011
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