Healthcare Provider Details

I. General information

NPI: 1538289491
Provider Name (Legal Business Name): VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6390 CASH MOUNTAIN RD
MALVERN AR
72104-9137
US

IV. Provider business mailing address

6390 CASH MOUNTAIN RD
MALVERN AR
72104-9137
US

V. Phone/Fax

Practice location:
  • Phone: 501-939-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberR43129
License Number StateAR

VIII. Authorized Official

Name: JUDY COX
Title or Position: CREDENTIALING PROGRAM SUPPORT
Credential:
Phone: 501-257-1484