Provider Demographics
NPI:1124032420
Name:VA MEDICAL CENTER
Entity Type:Organization
Organization Name:VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:LADD-SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:207-623-8411
Mailing Address - Street 1:24 W WALDO RD
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7640
Mailing Address - Country:US
Mailing Address - Phone:207-338-6996
Mailing Address - Fax:
Practice Address - Street 1:34 W WALDO RD
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7640
Practice Address - Country:US
Practice Address - Phone:207-338-6996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER026610286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital