Healthcare Provider Details

I. General information

NPI: 1861425076
Provider Name (Legal Business Name): VAMC HUNTINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DRIVE
HUNTINGTON WV
25704
US

IV. Provider business mailing address

1916 POPLAR STREET
KENOVA WV
25530
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6755
  • Fax:
Mailing address:
  • Phone: 304-453-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. RICHARD SANTOSTEFANO
Title or Position: PHYSICIAN'S ASSISTANT
Credential: PA-C
Phone: 304-429-6755