Healthcare Provider Details

I. General information

NPI: 1972529089
Provider Name (Legal Business Name): WJB DORN VETERNS 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

118 OLDE SPRINGS RD
COLUMBIA SC
29223-6022
US

IV. Provider business mailing address

118 OLDE SPRINGS RD
COLUMBIA SC
29223-6022
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number9588
License Number StateSC

VIII. Authorized Official

Name: DR. ZIAD A. AL-ASSAAD
Title or Position: CHIEF, PATHOLOGY & LAB MEDICINE SER
Credential: MD
Phone: 803-776-4000