Healthcare Provider Details

I. General information

NPI: 1760420426
Provider Name (Legal Business Name): VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE (117RT)
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

1153 GREENVIEW RD
COLLIERVILLE TN
38017-6884
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA COOK
Title or Position: RECREATION THERAPIST
Credential:
Phone: 901-523-8990