Healthcare Provider Details

I. General information

NPI: 1902118284
Provider Name (Legal Business Name): VETERAN'S AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR AUDIOLOGY 2S100
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR AUDIOLOGY 2S100
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-2375
  • Fax:
Mailing address:
  • Phone: 612-467-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number98
License Number StateAK

VIII. Authorized Official

Name: DR. AARON PENN
Title or Position: CLINIC SUPERVISOR
Credential: AU.D,
Phone: 612-467-2375