Healthcare Provider Details

I. General information

NPI: 1740555671
Provider Name (Legal Business Name): WM. BRYAN DORN VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2012
Last Update Date: 03/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 WILD OLIVE DR
COLUMBIA SC
29229-8179
US

IV. Provider business mailing address

244 WILD OLIVE DR
COLUMBIA SC
29229-8179
US

V. Phone/Fax

Practice location:
  • Phone: 803-736-1270
  • Fax:
Mailing address:
  • Phone: 803-736-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number87748
License Number StateSC

VIII. Authorized Official

Name: MS. SYREETA NICOLE MILLER
Title or Position: REGISTERED NURSE
Credential:
Phone: 803-736-1270