Provider Demographics
NPI:1669488938
Name:WJBDORN VA MEDICAL
Entity Type:Organization
Organization Name:WJBDORN VA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:KINESIOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCINER
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED
Authorized Official - Phone:803-776-4000
Mailing Address - Street 1:3012 PADGETT RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9765
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital