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General NPI Number Information
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NPI Number | 1710228929
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Entity Type | Organization
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Legal Business Name | VETERANS AFFIARS MEDICAL CENTER
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 100 EMANCIPATION DR
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City | HAMPTON
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State | VA
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Zip | 23667-0001
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Country | US
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Telephone | 757-722-9961
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Fax | 757-727-6052
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Provider Business Mailing Address
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Address Line | 1869 RIVER ROCK ARCH
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-6116
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Country | US
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Telephone | 757-417-0667
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Fax |
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Authorized Official
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Title or Position | PROGRAM SUPERVISOR
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Name | MRS. LILIA MARIA ADAMS
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Credential | LCSW,CSAC
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Telephone | 757-722-9961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 0710102010
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 0904007771
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License Number State | VA
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