Healthcare Provider Details

I. General information

NPI: 1912059098
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2335
US

IV. Provider business mailing address

6122 S IVANHOE AVE
YPSILANTI MI
48197-9707
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-7100
  • Fax: 734-973-9353
Mailing address:
  • Phone: 734-973-9345
  • Fax: 734-973-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number6801083874
License Number StateMI

VIII. Authorized Official

Name: MS. MAYME S THOMPSON
Title or Position: PROGRAM SUPPORT ASSISTANT
Credential:
Phone: 734-845-3007