=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255374377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VA HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 HOSPITAL DR UNIT 2C
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-5275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-814-6000
-----------------------------------------------------
Fax | 573-814-6493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 HOSPITAL DR UNIT 2C
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-5275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-814-6000
-----------------------------------------------------
Fax | 573-814-6493
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | READJUSTMENT COUNSELING THERAPIST
-----------------------------------------------------
Name | MR. DAVID JACKSON WINN
-----------------------------------------------------
Credential | MSW,LCSW
-----------------------------------------------------
Telephone | 573-814-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 2005013006
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------