Provider Demographics
NPI:1093021123
Name:VA MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:VA MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARISI
Authorized Official - Middle Name:JENNY
Authorized Official - Last Name:DUMERENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-623-8800
Mailing Address - Street 1:8233 FRESNO LN
Mailing Address - Street 2:UNIT 103
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-3633
Mailing Address - Country:US
Mailing Address - Phone:703-623-8800
Mailing Address - Fax:703-347-9639
Practice Address - Street 1:4810 BEAUREGARD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1709
Practice Address - Country:US
Practice Address - Phone:703-623-8800
Practice Address - Fax:703-347-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies