Provider Demographics
NPI:1043307317
Name:VAMC
Entity Type:Organization
Organization Name:VAMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHERNYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-270-0501
Mailing Address - Street 1:1405 NIGHTHAWK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6112
Mailing Address - Country:US
Mailing Address - Phone:405-216-0819
Mailing Address - Fax:
Practice Address - Street 1:921 N.E.13TH STR.
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-270-0501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23791282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital