Healthcare Provider Details

I. General information

NPI: 1780602896
Provider Name (Legal Business Name): VETERANS AFFAIS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG ROAD VAMC 515 / PSYCHOLOGY SERVICE 116B
BATTLE CREEK MI
49015
US

IV. Provider business mailing address

PO BOX 117
AUGUSTA MI
49012-0117
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax:
Mailing address:
  • Phone: 269-668-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number6301008704
License Number StateMI

VIII. Authorized Official

Name: DR. STEVE HENRY PENDZISZEWSKI
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 269-966-5600