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General NPI Number Information
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NPI Number | 1306922968
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Entity Type | Organization
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Legal Business Name | VA MEDICAL CENTER
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2335
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Country | US
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Telephone | 734-769-7100
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Fax | 734-769-7172
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Provider Business Mailing Address
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Address Line | 4500 WALDEN DR
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City | BLOOMFIELD
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State | MI
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Zip | 48301-1149
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Country | US
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Telephone | 248-855-3982
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Fax |
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Authorized Official
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Title or Position | PROGRAM SUPPORT ASSISTANT
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Name | MS. JAYME S THOMPSON
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Credential |
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Telephone | 734-845-3007
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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 | 4301036985
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License Number State | MI
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