Healthcare Provider Details

I. General information

NPI: 1225187669
Provider Name (Legal Business Name): JAMES H. QUILLEN VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S MAIN AVE
ERWIN TN
37650-1119
US

IV. Provider business mailing address

415 S MAIN AVE PO BOX 281
ERWIN TN
37650-1119
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-9058
  • Fax:
Mailing address:
  • Phone: 423-743-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberRN0000087275
License Number StateTN

VIII. Authorized Official

Name: MS. ELIZABETH ANN WOODS
Title or Position: REGISTERED NURSE
Credential:
Phone: 423-926-1171