Healthcare Provider Details

I. General information

NPI: 1831495415
Provider Name (Legal Business Name): U.S. DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE T100 (SOCIAL WORK)
BILOXI MS
39531-2410
US

IV. Provider business mailing address

15235 SAINT CHARLES ST
GULFPORT MS
39503-2822
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-4550
  • Fax:
Mailing address:
  • Phone: 228-261-0422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number StateMS

VIII. Authorized Official

Name: MS. TRYPHENA HUBBARD ELLIS
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 228-261-0422