Healthcare Provider Details

I. General information

NPI: 1679894158
Provider Name (Legal Business Name): ANN ARBOR VETERANS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-7100
  • Fax:
Mailing address:
  • Phone: 734-769-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number4704261581
License Number StateMI

VIII. Authorized Official

Name: MRS. AMY PATRICIA CUMMINGS
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 734-769-7100