Healthcare Provider Details

I. General information

NPI: 1760680854
Provider Name (Legal Business Name): DORN VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WILTSHIRE CT
COLUMBIA SC
29229-8762
US

IV. Provider business mailing address

PO BOX 290843
COLUMBIA SC
29229-0015
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-7990
  • Fax:
Mailing address:
  • Phone: 803-865-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberR106246
License Number StateSC

VIII. Authorized Official

Name: MOREENE ANGELA GRIFFITH
Title or Position: QM/ UTILIZATION NURSE
Credential:
Phone: 803-865-7990