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General NPI Number Information
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NPI Number | 1871742130
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Entity Type | Organization
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Legal Business Name | LOUIS STOKES VA MEDICAL CENTER
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 10701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 216-791-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 34426 PUTH DR
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City | AVON
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State | OH
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Zip | 44011-1916
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Country | US
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Telephone | 440-396-5461
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Fax |
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Authorized Official
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Title or Position | MANAGEMENT AND PROGRAM ANALYST
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Name | SUSAN PETRAK
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Credential |
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Telephone | 216-791-3800
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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 | 59.000233
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License Number State | OH
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