Healthcare Provider Details

I. General information

NPI: 1871688994
Provider Name (Legal Business Name): V A MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

125 W CHICAGO ST
LEBANON IN
46052-2149
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-0000
  • Fax:
Mailing address:
  • Phone: 765-482-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number33003179A
License Number StateIN

VIII. Authorized Official

Name: MS. PATRICIA KELSEY ERP
Title or Position: SOCIAL WORK ASSOCIATE
Credential: LSW
Phone: 317-554-0000