Provider Demographics
NPI:1346954930
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:TELEHEALTH COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:313-576-1000
Mailing Address - Street 1:4646 JOHN R ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1916
Mailing Address - Country:US
Mailing Address - Phone:313-576-1000
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty