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General NPI Number Information
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NPI Number | 1174979413
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Entity Type | Organization
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Legal Business Name | C,W. BILL YOUNG VA MEDICAL CENTER
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 521 ATWOOD AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702-6810
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Country | US
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Telephone | 727-526-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 734 42ND AVE S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33705-4416
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Country | US
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Telephone | 727-793-8405
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Fax |
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Authorized Official
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Title or Position | HUMAN RESOURCES
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Name | PAUL AYLLON
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Credential |
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Telephone | 727-398-6661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PN5213032
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License Number State | FL
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