Provider Demographics
NPI:1275991275
Name:JOHN D. DINGELL VA MEDICAL CENTER
Entity Type:Organization
Organization Name:JOHN D. DINGELL VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF VCRRC
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIEF, VETERANS COMM
Authorized Official - Phone:313-576-1581
Mailing Address - Street 1:4646 JOHN R ST
Mailing Address - Street 2:11MH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1916
Mailing Address - Country:US
Mailing Address - Phone:313-576-4950
Mailing Address - Fax:313-576-1074
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:11MH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-4950
Practice Address - Fax:313-576-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital