Healthcare Provider Details

I. General information

NPI: 1144455783
Provider Name (Legal Business Name): LOUIS STOKES VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 EAST 4TH ST APT #401
CLEVELAND OH
44115-1044
US

IV. Provider business mailing address

2082 EAST 4TH ST APT #401
CLEVELAND OH
44115-1044
US

V. Phone/Fax

Practice location:
  • Phone: 614-625-9161
  • Fax:
Mailing address:
  • Phone: 614-625-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN PETRAK
Title or Position: MANAGEMENT AND PROGRAM ANALYST
Credential:
Phone: 216-791-3800