Healthcare Provider Details

I. General information

NPI: 1881700094
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

1083 LANGFORD RD
BLYTHEWOOD SC
29016-9145
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone: 803-254-8527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number22132
License Number StateSC

VIII. Authorized Official

Name: MS. MARTHA L. MCINTYRE
Title or Position: MEDICAL STAFF COORDINATOR
Credential:
Phone: 803-776-4000