MEDICARE: DEPARTMENT OF VETERANS AFFAIRS

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	282N00000X	General Acute Care Hospital	282N00000X	FL

General Provider Information

NPI Number	:	1568630515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF VETERANS AFFAIRS

Provider Business Mailing Address
First Line	:	469 SW QUAIL HEIGHTS TER
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-1446
Country	:	US
Telephone Number	:	386-755-7597
Fax Number	:

Provider Business Practice Location Address
First Line	:	469 SW QUAIL HEIGHTS TER
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-1446
Country	:	US
Telephone Number	:	386-755-7597
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	MS. ANGELA VICTORIA HERRING
Credential	:
Telephone Number	:	386-755-3016

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/12/2008

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