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General NPI Number Information
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NPI Number | 1295186146
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERAN AFFAIRS
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 420 N JAMES RD
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City | COLUMBUS
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State | OH
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Zip | 43219-1834
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Country | US
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Telephone | 614-288-3103
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Fax |
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Provider Business Mailing Address
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Address Line | 420 N JAMES RD
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City | COLUMBUS
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State | OH
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Zip | 43219-1834
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Country | US
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Telephone | 614-288-3103
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Fax |
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Authorized Official
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Title or Position | SOCILA WORKER
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Name | MR. JUSTIN RICHARD BLACK
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Credential | LSW
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Telephone | 614-288-3103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | S1600341
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License Number State | OH
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