Provider Demographics
NPI:1053524421
Name:ZICKAFOOSE, JOSEPH SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SCOTT
Last Name:ZICKAFOOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-5100
Practice Address - Country:US
Practice Address - Phone:615-322-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57009054208000000X
OH35089753208000000X
MI4301095310208000000X
TNMD53314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH751032OtherBUCKEYE
OH415059OtherWELLCARE
PA1021146580001Medicaid
OH000000527973OtherANTHEM
OH2766878Medicaid
OH9569067OtherAETNA
OH000000221308OtherUNISON
OH9569067OtherAETNA