Provider Demographics
NPI:1235535329
Name:ALEXANDRIA VA HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:ALEXANDRIA VA HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-466-2861
Mailing Address - Street 1:2495 SHREVEPORT HWY 71
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-9004
Mailing Address - Country:US
Mailing Address - Phone:318-466-2861
Mailing Address - Fax:318-483-5128
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-466-2861
Practice Address - Fax:318-483-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAVAD000Medicare UPIN