Healthcare Provider Details

I. General information

NPI: 1619422052
Provider Name (Legal Business Name): VETERANS HEALTH ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 E CAMELBACK RD SUITE 210
PHOENIX AZ
85016-4764
US

IV. Provider business mailing address

2141 E CAMELBACK RD SUITE 210
PHOENIX AZ
85016-4764
US

V. Phone/Fax

Practice location:
  • Phone: 602-626-5997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License NumberAP131253
License Number StateTX

VIII. Authorized Official

Name: CARLY MELEWSKI
Title or Position: HR CONSULTANT
Credential:
Phone: 216-791-2300