Provider Demographics
NPI:1083015267
Name:VA EASTERN KANSAS HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:VA EASTERN KANSAS HEALTH CARE SYSTEM
Other - Org Name:DWIGHT D. EISENHOWER VA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GADDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:913-682-2000
Mailing Address - Street 1:4101 S 4TH ST
Mailing Address - Street 2:MAIN HOSPITAL, A2, ROOM A629
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5014
Mailing Address - Country:US
Mailing Address - Phone:913-682-2000
Mailing Address - Fax:913-758-4277
Practice Address - Street 1:4101 S 4TH ST
Practice Address - Street 2:MAIN HOSPITAL, A2, ROOM A629
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:913-758-4277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF VETERANS AFFAIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2244251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health