Healthcare Provider Details

I. General information

NPI: 1790889053
Provider Name (Legal Business Name): CENTERAL ALABAMA VETERANS HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

IV. Provider business mailing address

850 WINGARD ST
PRATTVILLE AL
36066-5828
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-4670
  • Fax: 334-273-6227
Mailing address:
  • Phone: 334-365-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number80
License Number StateAL

VIII. Authorized Official

Name: MISS TRACEY ELAINE THORNTON
Title or Position: CLINICAL DIETITIAN
Credential: RD/LD
Phone: 334-272-4670