1558398701 NPI number — VETERAN AFFAIRS MEDICAL CENTER

Table of content: (NPI 1558398701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558398701 NPI number — VETERAN AFFAIRS MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VETERAN AFFAIRS MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558398701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 BRADLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRON MOUNTAIN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49801-6657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-774-0362
Provider Business Mailing Address Fax Number:
906-779-3180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 H EAST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRONMOUNTAIN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49801-6657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-774-3300
Provider Business Practice Location Address Fax Number:
906-779-3143
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGH
Authorized Official First Name:
HARNINDER SINGH
Authorized Official Middle Name:
-
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
906-774-3300

Provider Taxonomy Codes

  • Taxonomy code: 281P00000X , with the licence number:  4301081826 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 282N00000X , with the licence number: 4301081826 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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