Healthcare Provider Details

I. General information

NPI: 1407030174
Provider Name (Legal Business Name): VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRL
RIVIERA BEACH FL
33410-7417
US

IV. Provider business mailing address

7305 MILITARY TR
WEST PALM BEACH FL
33410-7816
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-5751
  • Fax:
Mailing address:
  • Phone: 561-422-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA ELIZABETH PRIEL
Title or Position: MEDICAL TECHNOLGIST
Credential:
Phone: 561-433-2952