Provider Demographics
NPI:1225276843
Name:CINCINNATI VA MEDICAL CENTER
Entity Type:Organization
Organization Name:CINCINNATI VA MEDICAL CENTER
Other - Org Name:DEPARTMENT OF VETERANS AFFAIRS
Other - Org Type:Other Name
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAGERSTRAND
Authorized Official - Suffix:SR
Authorized Official - Credentials:CO
Authorized Official - Phone:513-861-3100
Mailing Address - Street 1:3200 VINE ST
Mailing Address - Street 2:539/121
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2213
Mailing Address - Country:US
Mailing Address - Phone:513-861-3100
Mailing Address - Fax:513-487-6693
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:539/121
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:513-487-6693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF VETERANS AFFAIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital