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General NPI Number Information
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NPI Number | 1841538071
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Entity Type | Organization
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Legal Business Name | PHOENIX VA HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 232 S 12TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85007-3101
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Country | US
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Telephone | 602-510-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 650 E INDIAN SCHOOL RD
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City | PHOENIX
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State | AZ
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Zip | 85012-1839
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MR. JOHN NELSON MCVADE JR.
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Credential | LMSW
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Telephone | 602-510-7971
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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 | LMSW-13456
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License Number State | AZ
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