Healthcare Provider Details

I. General information

NPI: 1841216983
Provider Name (Legal Business Name): WJB DORN VETERAN ADMINISTRATION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 SPRING POINT DR
COLUMBIA SC
29229-8940
US

IV. Provider business mailing address

324 SPRING POINT DR
COLUMBIA SC
29229-8940
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax: 803-695-6772
Mailing address:
  • Phone: 803-865-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PETER BOTROUS
Title or Position: DIRECTOR, ANATOMICAL PATHOLOGY
Credential: MD
Phone: 803-776-4000