Provider Demographics
NPI:1326123050
Name:ALEXANDRI VA MEDICAL CENTER
Entity Type:Organization
Organization Name:ALEXANDRI VA MEDICAL CENTER
Other - Org Name:PSYCHIATRY/CHEMICAL DEPENDENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAS/ADDICTION THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:SR
Authorized Official - Credentials:AMERICAN ACADEMY
Authorized Official - Phone:318-473-0010
Mailing Address - Street 1:2495 SHREVEPORT HYW 71NORTH
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-473-0010
Mailing Address - Fax:318-483-5176
Practice Address - Street 1:2495 SHREVEPORT HYW 71NORTH
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:318-483-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4280282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital