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General NPI Number Information
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NPI Number | 1871688994
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Entity Type | Organization
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Legal Business Name | V A MEDICAL CENTER
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1481 W 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2803
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Country | US
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Telephone | 317-554-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 125 W CHICAGO ST
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City | LEBANON
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State | IN
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Zip | 46052-2149
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Country | US
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Telephone | 765-482-0886
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORK ASSOCIATE
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Name | MS. PATRICIA KELSEY ERP
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Credential | LSW
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Telephone | 317-554-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 33003179A
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License Number State | IN
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