Healthcare Provider Details

I. General information

NPI: 1891034245
Provider Name (Legal Business Name): CARL T. HAYDEN VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax: 602-200-6037
Mailing address:
  • Phone: 602-277-5551
  • Fax: 602-200-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberLMSW-12218
License Number StateAZ

VIII. Authorized Official

Name: SHARON HELMAN
Title or Position: DIRECTOR
Credential:
Phone: 602-277-5551