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General NPI Number Information
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NPI Number | 1740555671
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Entity Type | Organization
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Legal Business Name | WM. BRYAN DORN VA MEDICAL CENTER
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Dates
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Enumeration Date | 03/10/2012
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Last Update Date | 03/10/2012
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Provider Practice Location Address
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Address Line | 244 WILD OLIVE DR
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City | COLUMBIA
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State | SC
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Zip | 29229-8179
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Country | US
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Telephone | 803-736-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 244 WILD OLIVE DR
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City | COLUMBIA
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State | SC
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Zip | 29229-8179
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Country | US
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Telephone | 803-736-1270
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MS. SYREETA NICOLE MILLER
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Credential |
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Telephone | 803-736-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number | 87748
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License Number State | SC
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