Healthcare Provider Details

I. General information

NPI: 1790791143
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

3046 RIVERSIDE AVE
SOMERSET MA
02726-5322
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 508-673-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberLPN08256
License Number StateRI

VIII. Authorized Official

Name: MRS. EILEEN M CHMIELEWSKI
Title or Position: LPN
Credential: LPN
Phone: 401-273-7100