Provider Demographics
NPI:1518188572
Name:DEPARTMENT OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:VA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPR.DX.RAD.TECH
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:DUKE
Authorized Official - Last Name:ANNE
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT 168507
Authorized Official - Phone:901-577-7260
Mailing Address - Street 1:4625 SHADOW VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4776
Mailing Address - Country:US
Mailing Address - Phone:901-268-4419
Mailing Address - Fax:901-577-7466
Practice Address - Street 1:4625 SHADOW VALLEY LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4776
Practice Address - Country:US
Practice Address - Phone:901-268-4419
Practice Address - Fax:901-577-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN168506OtherARRT