Provider Demographics
NPI:1457637829
Name:DEPT OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:DEPT OF VETERANS AFFAIRS
Other - Org Name:MCGUIRE VA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-675-5000
Mailing Address - Street 1:1201 BROAD ROCK BLVD
Mailing Address - Street 2:2L147
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249-0001
Mailing Address - Country:US
Mailing Address - Phone:804-675-5000
Mailing Address - Fax:804-675-5667
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:2L147
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007555286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904007555OtherLICENSED CLINICAL SOCIAL WORKER