Provider Demographics
NPI:1164509477
Name:VETERANS AFFAIRS MEDICAL CENTER
Entity Type:Organization
Organization Name:VETERANS AFFAIRS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, SURGICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ADETOLA
Authorized Official - Last Name:ADEBONOJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-262-5965
Mailing Address - Street 1:2946 KINGS GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3900
Mailing Address - Country:US
Mailing Address - Phone:937-320-1890
Mailing Address - Fax:
Practice Address - Street 1:2946 KINGS GATE BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3900
Practice Address - Country:US
Practice Address - Phone:937-320-1890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009732E282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital