MEDICARE: VA MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	286500000X	Military Hospital	RN202364	GA
2	251J00000X	Nursing Care Agency	RN9257726	FL

General Provider Information

NPI Number	:	1093049520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	5416 ORANGE VALLEY DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2649
Country	:	US
Telephone Number	:	863-602-4131
Fax Number	:

Provider Business Practice Location Address
First Line	:	5416 ORANGE VALLEY DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2649
Country	:	US
Telephone Number	:	863-602-4131
Fax Number	:

Authorized Official
Title or Position	:	RN/EMERGENCY NURSING
Name	:	VETA SHANTAYE KEYS
Credential	:
Telephone Number	:	863-602-4131

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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Directions to “VA MEDICAL CENTER ” Practice Location

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