Provider Demographics
NPI:1073552758
Name:DEPARTMENT OF VETERAN'S AFFAIRS--TOMAH VA MEDICAL CENTER
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERAN'S AFFAIRS--TOMAH VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PM&RS SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-372-3971
Mailing Address - Street 1:425 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1225
Mailing Address - Country:US
Mailing Address - Phone:715-299-0529
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:PM&RS, KT 402/1220 CLINIC
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:608-372-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital