1336348911 NPI number — DORN VAMC

Table of content: (NPI 1336348911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336348911 NPI number — DORN VAMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DORN VAMC
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:
1336348911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
702 WHITEWATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRMO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29063-7809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-730-2463
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6439 GARNERS FERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29209-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-776-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLSON
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
SOCIAL WORKER
Authorized Official Telephone Number:
803-776-4000

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  5616 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: V010600 . This is a "SOCIAL WORKER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com