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General NPI Number Information
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NPI Number | 1659411478
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Entity Type | Organization
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Legal Business Name | CANANDAIGU VA MEDICAL CENTER
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 FORT HILL AVE
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1159
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Country | US
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Telephone | 607-566-2276
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Fax |
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Provider Business Mailing Address
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Address Line | 10294 COUNTY ROUTE 7
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City | PRATTSBURGH
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State | NY
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Zip | 14873-9456
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Country | US
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Telephone | 607-566-2276
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Fax |
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Authorized Official
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Title or Position | REGISTERD NURSE
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Name | SCOTT ROBERT BUMP
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Credential |
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Telephone | 585-393-7226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 47165-1
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License Number State | NY
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