Healthcare Provider Details

I. General information

NPI: 1295777829
Provider Name (Legal Business Name): VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

400 VETERANS AVE
BILOXI MS
39531-2410
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5000
  • Fax:
Mailing address:
  • Phone: 228-523-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number0904004044
License Number StateVA

VIII. Authorized Official

Name: MS. MARLENE MILLER BRYANT
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 228-523-5000