Provider Demographics
NPI:1003073917
Name:DEPT OF VETERAN AFFAIRS
Entity Type:Organization
Organization Name:DEPT OF VETERAN AFFAIRS
Other - Org Name:CWT-438 SD
Other - Org Type:Other Name
Authorized Official - Title/Position:SE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-336-3230
Mailing Address - Street 1:2501 W 22ND ST
Mailing Address - Street 2:116A
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1305
Mailing Address - Country:US
Mailing Address - Phone:605-336-3632
Mailing Address - Fax:605-333-6804
Practice Address - Street 1:2501 W 22ND ST SF VA MEDICAL CENTER
Practice Address - Street 2:116A
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57117
Practice Address - Country:US
Practice Address - Phone:605-336-3230
Practice Address - Fax:605-333-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD283Q00000XOtherSF VA MEDICAL CENTER