Healthcare Provider Details

I. General information

NPI: 1316103088
Provider Name (Legal Business Name): VETERANS AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

14506 HIGHGATE HILL CT
CHESTERFIELD VA
23832-2457
US

IV. Provider business mailing address

14506 HIGHGATE HILL CT
CHESTERFIELD VA
23832-2457
US

V. Phone/Fax

Practice location:
  • Phone: 804-739-6810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: JACQUELIN WILLIAMS
Title or Position: CREDENTIALING COORDINATOR (05F)
Credential:
Phone: 757-722-9961