Provider Demographics
NPI:1427201813
Name:VA MEDICAL CENTER MOUNTAIN HOME, TN
Entity Type:Organization
Organization Name:VA MEDICAL CENTER MOUNTAIN HOME, TN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:TESTERMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:423-926-1171
Mailing Address - Street 1:1ST STREET, BLDG 204
Mailing Address - Street 2:JAMES H. QUILLEN VA MEDICAL CENTER EMERGENCY DEPT
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:
Practice Address - Street 1:1ST STREET BLDG 204
Practice Address - Street 2:JAMES H. QUILLEN VA MEDICAL CENTER EMERGENCY DEPT
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684-4000
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNPA036282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital