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General NPI Number Information
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NPI Number | 1467730952
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Entity Type | Organization
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Legal Business Name | JACK C. MONTGOMERY VA MEDICAL CENTER
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 102 YORK VILLAGE DR APT 1
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City | MUSKOGEE
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State | OK
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Zip | 74403-4843
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Country | US
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Telephone | 918-616-4626
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Fax |
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Provider Business Mailing Address
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Address Line | 102 YORK VILLAGE DR APT 1
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City | MUSKOGEE
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State | OK
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Zip | 74403-4843
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Country | US
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Telephone | 918-616-4626
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Fax |
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Authorized Official
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Title or Position | CHIEF, VOLUNTARY SERVICES
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Name | GREGORY SORENSON
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Credential |
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Telephone | 918-577-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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