University Health System, Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

UNIVERSITY HEALTH SYSTEM, INC

Doing business as

UT Internal Medicine Jefferson City

Practice address

1413 Russell Ave
Jefferson City, TN 37760-2562

Phone

(865) 670-6199

Fax

(865) 670-6188

NPI assigned

Oct 7, 2010

Last updated

Jun 10, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cynthia B. Marquart

Title

Vice President

Phone

(865) 305-9886

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• UT Internal Medicine Jefferson City Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307664000000",
    "number": "1083923197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 440476",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372440476",
            "telephone_number": "865-670-6199",
            "fax_number": "865-670-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 RUSSELL AVE",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "377602562",
            "telephone_number": "865-670-6199",
            "fax_number": "865-670-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-07",
        "last_updated": "2011-06-10",
        "status": "A",
        "authorized_official_last_name": "MARQUART",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "865-305-9886"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1521415",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UT Internal Medicine Jefferson City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hong I Tjoa, MD
• Laura Holeman Trahan, PHARMD
• David Scott Turner Jr., PHARM D
• Unc Style Barbershop and Suites, LLC
• Unity Medical Group PLLC
• Michael Todd Vanbruggen, ATC
• Ricky Varney, LPC-MHSP
• Albert Russell Vaughn, MD
• Patricia Annette Waddell, FNP
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-0724)

• Internal Medicine Physician in Jefferson City, TN
• Providers in Jefferson City, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.