Healthcare Provider Details

I. General information

NPI: 1124302872
Provider Name (Legal Business Name): DEPARTMENT OF VETERAN AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax: 859-281-4993
Mailing address:
  • Phone: 859-233-4511
  • Fax: 859-281-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JONATHAN HERST
Title or Position: CNH SOCIAL WORKER
Credential: MSW,CSW
Phone: 859-233-4511