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General NPI Number Information
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NPI Number | 1043307317
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Entity Type | Organization
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Legal Business Name | VAMC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 921 N.E.13TH STR.
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104
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Country | US
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Telephone | 405-270-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 NIGHTHAWK DR
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City | EDMOND
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State | OK
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Zip | 73034-6112
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Country | US
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Telephone | 405-216-0819
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Fax |
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Authorized Official
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Title or Position | ANESTHESIOLOGIST
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Name | DR. GRIGORY V. CHERNYAK
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Credential | M.D.
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Telephone | 405-270-0501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 23791
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License Number State | OK
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