Healthcare Provider Details

I. General information

NPI: 1518188572
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 SHADOW VALLEY LN
ARLINGTON TN
38002-4776
US

IV. Provider business mailing address

4625 SHADOW VALLEY LN
ARLINGTON TN
38002-4776
US

V. Phone/Fax

Practice location:
  • Phone: 901-268-4419
  • Fax: 901-577-7466
Mailing address:
  • Phone: 901-268-4419
  • Fax: 901-577-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARILYN DUKE ANNE
Title or Position: SUPR.DX.RAD.TECH
Credential: ARRT 168507
Phone: 901-577-7260