MEDICARE: VETERANS HEALTH ADMINISTRATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QV0200X	VA Clinic/Center	AP131253	TX

General Provider Information

NPI Number	:	1619422052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERANS HEALTH ADMINISTRATION

Provider Business Mailing Address
First Line	:	2141 E CAMELBACK RD
Second Line	:	SUITE 210
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 E CAMELBACK RD
Second Line	:	SUITE 210
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4764
Country	:	US
Telephone Number	:	602-626-5997
Fax Number	:

Authorized Official
Title or Position	:	HR CONSULTANT
Name	:	CARLY MELEWSKI
Credential	:
Telephone Number	:	216-791-2300

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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