Provider Demographics
NPI:1659411478
Name:CANANDAIGU VA MEDICAL CENTER
Entity Type:Organization
Organization Name:CANANDAIGU VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERD NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BUMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-393-7226
Mailing Address - Street 1:10294 COUNTY ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:PRATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:14873-9456
Mailing Address - Country:US
Mailing Address - Phone:607-566-2276
Mailing Address - Fax:
Practice Address - Street 1:400 FORT HILL AVE
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1159
Practice Address - Country:US
Practice Address - Phone:607-566-2276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47165-1283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital