Healthcare Provider Details

I. General information

NPI: 1710315981
Provider Name (Legal Business Name): HUNTINGTON VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR BUILDING 5
HUNTINGTON WV
25704-9300
US

IV. Provider business mailing address

1540 SPRING VALLEY DR BUILDING 5
HUNTINGTON WV
25704-9300
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax:
Mailing address:
  • Phone: 304-429-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number3566
License Number StateKY

VIII. Authorized Official

Name: MR. JIM MORRIS
Title or Position: SUPERVISORY SOCIAL WORKER
Credential: LICSW
Phone: 304-429-0287