Provider Demographics
NPI:1053385963
Name:UNIVERSITY OF TENNESSEE
Entity type:Organization
Organization Name:UNIVERSITY OF TENNESSEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VICE CHANCELLOR CHIEF FINANCIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-448-5523
Mailing Address - Street 1:875 UNION AVE
Mailing Address - Street 2:ROOM E201
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103
Mailing Address - Country:US
Mailing Address - Phone:901-448-6224
Mailing Address - Fax:901-448-2853
Practice Address - Street 1:875 UNION AVE
Practice Address - Street 2:ROOM C209
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-0001
Practice Address - Country:US
Practice Address - Phone:901-448-6267
Practice Address - Fax:901-448-2853
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF TENNESSEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-15
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8784OtherSTATE LICENSE