Provider Demographics
NPI:1487723094
Name:UNIVERSITY OF TENNESSEE
Entity type:Organization
Organization Name:UNIVERSITY OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE CHANCELLOR CHIEF FINANCIAL
Authorized Official - Prefix:
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 C309
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-0001
Mailing Address - Country:US
Mailing Address - Phone:901-448-5876
Mailing Address - Fax:901-448-6835
Practice Address - Street 1:875 UNION AVE
Practice Address - Street 2:ROOM C309
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0001
Practice Address - Country:US
Practice Address - Phone:901-448-5876
Practice Address - Fax:901-448-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3226474Medicare PIN