Healthcare Provider Details

I. General information

NPI: 1528239621
Provider Name (Legal Business Name): VETERANS ADMINISTRATION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HEATHMAN ROAD WHITE HALL, RM 309
KINGSTON RI
02881
US

IV. Provider business mailing address

50 STEUBEN ST
PROVIDENCE RI
02909-3112
US

V. Phone/Fax

Practice location:
  • Phone: 401-874-5342
  • Fax:
Mailing address:
  • Phone: 850-294-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberRN 38958
License Number StateRI

VIII. Authorized Official

Name: DEBORAH BURROWS
Title or Position: MEDICAL AFFAIRS OFFICER
Credential:
Phone: 401-273-7100