Healthcare Provider Details

I. General information

NPI: 1578850285
Provider Name (Legal Business Name): VETERANS AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMANCIPATION DR
HAMPTON VA
23667-0001
US

IV. Provider business mailing address

100 EMANCIPATION DR
HAMPTON VA
23667-0001
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax: 757-728-3183
Mailing address:
  • Phone: 757-722-9961
  • Fax: 757-728-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number8300
License Number StateTN

VIII. Authorized Official

Name: ANTHONY MILLER
Title or Position: LICENSED SOCIAL WORKER
Credential:
Phone: 757-722-9961