Healthcare Provider Details

I. General information

NPI: 1699098665
Provider Name (Legal Business Name): MARION VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WEST MAIN
MARION IL
62959
US

IV. Provider business mailing address

2920 DELOA LANE
HERRIN IL
62948
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: JEFF MORRISON
Title or Position: SUYPERVISOR
Credential:
Phone: 618-997-5311