Healthcare Provider Details

I. General information

NPI: 1871673624
Provider Name (Legal Business Name): VETERANS AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

219 ABERDEEN AVE
DAYTON OH
45419-3202
US

V. Phone/Fax

Practice location:
  • Phone: 937-262-2150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER B MOORE
Title or Position: SURGERY RESIDENT
Credential: M.D.
Phone: 937-262-2150