Provider Demographics
NPI:1356680052
Name:VA PUGET SOUND HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:VA PUGET SOUND HEALTH CARE SYSTEM
Other - Org Name:FEDERAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:VOCATIONAL REHABILITATION SPECIALIS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:LEVERETTE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:253-583-2829
Mailing Address - Street 1:9600 VETERANS DR SW
Mailing Address - Street 2:A-116-148
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-5000
Mailing Address - Country:US
Mailing Address - Phone:253-583-2829
Mailing Address - Fax:253-589-4042
Practice Address - Street 1:9600 VETERANS DR SW
Practice Address - Street 2:A-116-148
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-5000
Practice Address - Country:US
Practice Address - Phone:253-583-2829
Practice Address - Fax:253-589-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital