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General NPI Number Information
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NPI Number | 1740610740
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Entity Type | Organization
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Legal Business Name | DEPT. OF VETERAN AFFAIRS
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 1500 E WOODROW WILSON AVE
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City | JACKSON
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State | MS
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Zip | 39216-5116
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Country | US
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Telephone | 601-362-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 E WOODROW WILSON AVE
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City | JACKSON
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State | MS
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Zip | 39216-5116
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Country | US
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Telephone | 601-362-4471
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Fax |
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Authorized Official
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Title or Position | BLIND REHAB OUTPATIENT SPECIALIST
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Name | MR. THOMAS J STELMA III
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Credential | COMS
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Telephone | 601-362-4471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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