Provider Demographics
NPI:1801121074
Name:UNIVERSITY OF THE SOUTH HEALTH SERVICES
Entity type:Organization
Organization Name:UNIVERSITY OF THE SOUTH HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-598-1270
Mailing Address - Street 1:1310 UNIVERSITY AVE
Mailing Address - Street 2:SPO 1182
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-2336
Mailing Address - Country:US
Mailing Address - Phone:931-598-1270
Mailing Address - Fax:931-598-1746
Practice Address - Street 1:1310 UNIVERSITY AVE
Practice Address - Street 2:SPO 1182
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2336
Practice Address - Country:US
Practice Address - Phone:931-598-1270
Practice Address - Fax:931-598-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0006489208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty