Healthcare Provider Details

I. General information

NPI: 1679745475
Provider Name (Legal Business Name): LOUIS A JOHNSON VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR.
CLARKSBURG WV
26301
US

IV. Provider business mailing address

1 MEDICAL CENTER DR.
CLARKSBURG WV
26301
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax:
Mailing address:
  • Phone: 304-623-3461
  • Fax: 304-623-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number30571
License Number StateWV

VIII. Authorized Official

Name: MR. WILLIAM COX
Title or Position: DIRECTOR
Credential:
Phone: 304-623-3461