Provider Demographics
NPI:1457447088
Name:VA MEDICAL CENTER
Entity Type:Organization
Organization Name:VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-393-2863
Mailing Address - Street 1:1299 GILPIN ST
Mailing Address - Street 2:PARK TOWERS
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2553
Mailing Address - Country:US
Mailing Address - Phone:303-393-2863
Mailing Address - Fax:
Practice Address - Street 1:1055 CLERMONT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3808
Practice Address - Country:US
Practice Address - Phone:303-393-2863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty