Healthcare Provider Details

I. General information

NPI: 1285960690
Provider Name (Legal Business Name): VERTERN'S AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE
MARTINSBURG WV
25405-9990
US

IV. Provider business mailing address

510 BUTLER AVE
MARTINSBURG WV
25405-9990
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax: 304-262-4844
Mailing address:
  • Phone: 304-263-0811
  • Fax: 304-262-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberKY-903
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberC7013
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberDP00943390
License Number StateWV

VIII. Authorized Official

Name: DR. EURONE NMN GRAHAM
Title or Position: ER MENTAL HEALTH CONSULTANT
Credential: PHD, LCSW, LICSW
Phone: 304-263-0811