Provider Demographics
NPI:1679654966
Name:VA GULF COAST VETERAN HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:VA GULF COAST VETERAN HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ENTEROSTOMAL THERAPY NURSE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CWOCN
Authorized Official - Phone:228-523-5000
Mailing Address - Street 1:400 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2410
Mailing Address - Country:US
Mailing Address - Phone:228-523-5000
Mailing Address - Fax:228-523-4342
Practice Address - Street 1:855 ON THE GRN
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-3229
Practice Address - Country:US
Practice Address - Phone:228-388-6480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR598283282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital