Provider Demographics
NPI:1083803696
Name:VETERAN'S ADMINISTRATION
Entity Type:Organization
Organization Name:VETERAN'S ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-434-7000
Mailing Address - Street 1:4324 W WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4518 N ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1901
Practice Address - Country:US
Practice Address - Phone:509-434-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001879252Y00000X, 261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No252Y00000XAgenciesEarly Intervention Provider Agency