Healthcare Provider Details

I. General information

NPI: 1124124508
Provider Name (Legal Business Name): ALEDA E. LUTA VETERANS ADMINISTRATION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10295 SARLE RD
FREELAND MI
48623-9012
US

IV. Provider business mailing address

10295 SARLE RD
FREELAND MI
48623-9012
US

V. Phone/Fax

Practice location:
  • Phone: 989-695-5041
  • Fax:
Mailing address:
  • Phone: 989-695-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number4704118146
License Number StateMI

VIII. Authorized Official

Name: ROXANA SOVA
Title or Position: FAMILY NURSE PRACTITIONER-MSN, APRN
Credential:
Phone: 989-497-2500