Healthcare Provider Details

I. General information

NPI: 1447578786
Provider Name (Legal Business Name): JAMES H. QUILLEN VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 BABBS MILL RD
AFTON TN
37616-4254
US

IV. Provider business mailing address

2755 BABBS MILL RD
AFTON TN
37616-4254
US

V. Phone/Fax

Practice location:
  • Phone: 423-552-0457
  • Fax:
Mailing address:
  • Phone: 423-552-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number132704
License Number StateTN

VIII. Authorized Official

Name: ANGELA MICHELE COVINGTON
Title or Position: REGISTERED NURSE
Credential:
Phone: 423-552-0457