Healthcare Provider Details

I. General information

NPI: 1063594885
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

PO BOX 69004
ALEXANDRIA LA
71306-9004
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0010
  • Fax:
Mailing address:
  • Phone: 318-473-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS WIGGINTON
Title or Position: CHIEF OF CHAPLAINS
Credential:
Phone: 318-473-0010