Healthcare Provider Details

I. General information

NPI: 1497810188
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 61 BOX 2029 260 CANDY KITCHEN RD
RAMAH NM
87321-9608
US

IV. Provider business mailing address

HC 61 BOX 2029 260 CANDY KITCHEN RD
RAMAH NM
87321-9608
US

V. Phone/Fax

Practice location:
  • Phone: 505-775-3276
  • Fax:
Mailing address:
  • Phone: 505-775-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberR48833
License Number StateNM

VIII. Authorized Official

Name: MR. SHIRLEY ELAINE ROPER
Title or Position: TOUR SUPERVISOR
Credential: R.N.
Phone: 505-265-1711