1235535329 NPI number — ALEXANDRIA VA HEALTH CARE SYSTEM

Table of content: (NPI 1235535329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235535329 NPI number — ALEXANDRIA VA HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEXANDRIA VA HEALTH CARE SYSTEM
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:
1235535329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2495 SHREVEPORT HWY 71
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71360-9004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-466-2861
Provider Business Mailing Address Fax Number:
318-483-5128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2495 SHREVEPORT HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-466-2861
Provider Business Practice Location Address Fax Number:
318-483-5128
Provider Enumeration Date:
11/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LOVE
Authorized Official First Name:
RICKY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
FACILITY REVENUE MANAGER
Authorized Official Telephone Number:
318-466-2861

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com