Healthcare Provider Details

I. General information

NPI: 1598994238
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-9718
US

IV. Provider business mailing address

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-9718
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-1141
  • Fax:
Mailing address:
  • Phone: 740-773-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number4755
License Number StateOH

VIII. Authorized Official

Name: SHEILA E JORDAN
Title or Position: SUPVR. CARDIOPULMONARY SVC
Credential: R.R.T.
Phone: 740-773-1141