MEDICARE: OVERTON BROOKS VA MED 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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1639354863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVERTON BROOKS VA MED CENTER

Provider Business Mailing Address
First Line	:	208 FORT ST
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055-4342
Country	:	US
Telephone Number	:	318-751-7477
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 FORT ST
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055-4342
Country	:	US
Telephone Number	:	318-751-7477
Fax Number	:

Authorized Official
Title or Position	:	NURSE
Name	:	SKYE TERRELL
Credential	:
Telephone Number	:	318-424-6067

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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