Healthcare Provider Details

I. General information

NPI: 1669550117
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LOOP RD
TUSCALOOSA AL
35404-5015
US

IV. Provider business mailing address

4435 MONTE VISTA CIR
TUSCALOOSA AL
35405-4632
US

V. Phone/Fax

Practice location:
  • Phone: 205-554-2000
  • Fax:
Mailing address:
  • Phone: 205-556-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. WAYNE C WILSON
Title or Position: KINESIOTHERAPIST
Credential:
Phone: 205-554-3797