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General NPI Number Information
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NPI Number | 1790083475
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Entity Type | Organization
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Legal Business Name | VA CENTER
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 510 BUTLER AVE
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City | MARTINSBURG
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State | WV
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Zip | 25405-9990
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Country | US
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Telephone | 304-263-0811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 501
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City | KEARNEYSVILLE
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State | WV
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Zip | 25430-0501
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Country | US
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Telephone | 304-876-3529
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Fax |
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Authorized Official
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Title or Position | MEDICAL STAFF DIRECTOR
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Name | MRS. KIMBERLY MCDIFFITT
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Credential | CPMSM,CPCS
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Telephone | 304-263-0811
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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 | 59640
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License Number State | WV
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