Healthcare Provider Details

I. General information

NPI: 1972685808
Provider Name (Legal Business Name): RALPH H. JOHNSON VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

2040 ASHLEY RIVER RD
CHARLESTON SC
29407-4752
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7311
  • Fax: 803-789-6290
Mailing address:
  • Phone: 843-402-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberE38112
License Number StateCT

VIII. Authorized Official

Name: MRS. DEBORAH LAVERNE SANBORN
Title or Position: CLINICAL SPECIALIST
Credential: MSN
Phone: 843-789-7311