Healthcare Provider Details

I. General information

NPI: 1477893402
Provider Name (Legal Business Name): PHOENIX VA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1845
US

IV. Provider business mailing address

605 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1845
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number6857
License Number StateAZ

VIII. Authorized Official

Name: DR. LI LI
Title or Position: CHIEF OF PHYSICAL MEDICINE
Credential:
Phone: 602-277-5551