Provider Demographics
NPI:1417345471
Name:WJBD VA MEDICAL FACILITY
Entity Type:Organization
Organization Name:WJBD VA MEDICAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SOCIAL WORK
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERREE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-776-4000
Mailing Address - Street 1:190 WINDSOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7955
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6289282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital