Provider Demographics
NPI:1043650815
Name:DEPARTMENT OF VETERAN'S AFFAIRS
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERAN'S AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-728-3100
Mailing Address - Street 1:100 EMANCIPATION DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23667-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-728-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA57278284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA57278OtherNATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION