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General NPI Number Information
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NPI Number | 1972685808
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Entity Type | Organization
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Legal Business Name | RALPH H. JOHNSON VA MEDICAL CENTER
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 109 BEE ST
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City | CHARLESTON
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State | SC
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Zip | 29401-5703
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Country | US
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Telephone | 843-789-7311
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Fax | 803-789-6290
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Provider Business Mailing Address
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Address Line | 2040 ASHLEY RIVER RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4752
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Country | US
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Telephone | 843-402-0126
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Fax |
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Authorized Official
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Title or Position | CLINICAL SPECIALIST
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Name | MRS. DEBORAH LAVERNE SANBORN
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Credential | MSN
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Telephone | 843-789-7311
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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 | E38112
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License Number State | CT
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