Provider Demographics
NPI:1518157551
Name:MALCOM RANDALL VA MEDICAL CENTER
Entity Type:Organization
Organization Name:MALCOM RANDALL VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE-BSN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:352-376-1611
Mailing Address - Street 1:3800 S.W 34TH STREET
Mailing Address - Street 2:APT. GG-334
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:352-367-4351
Mailing Address - Fax:
Practice Address - Street 1:1601 S.W ARCHER ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-374-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL828464282NC0060X
PR024871282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access