1831495415 NPI number — U.S. DEPARTMENT OF VETERANS AFFAIRS

Table of content: (NPI 1831495415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831495415 NPI number — U.S. DEPARTMENT OF VETERANS AFFAIRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
U.S. DEPARTMENT OF VETERANS AFFAIRS
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:
1831495415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15235 SAINT CHARLES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39503-2822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-261-0422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 VETERANS AVE
Provider Second Line Business Practice Location Address:
T100 (SOCIAL WORK)
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39531-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-523-4550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
TRYPHENA
Authorized Official Middle Name:
HUBBARD
Authorized Official Title or Position:
SOCIAL WORKER
Authorized Official Telephone Number:
228-261-0422

Provider Taxonomy Codes

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

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

  • Identifier: 340727612 . This is a "VETERAN AFFAIRS HEALTH CARE SYSTEM" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".