Provider Demographics
NPI:1710181003
Name:FAYETTEVILLE VA MEDICAL CENTER
Entity Type:Organization
Organization Name:FAYETTEVILLE VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEEMIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:910-488-2120
Mailing Address - Street 1:8202 MCGUIRE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-7702
Mailing Address - Country:US
Mailing Address - Phone:919-179-1474
Mailing Address - Fax:
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP003421282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital