Provider Demographics
NPI:1740200757
Name:LOUIS A. JOHNSON VAMC
Entity Type:Organization
Organization Name:LOUIS A. JOHNSON VAMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAC-CERTIFIED
Authorized Official - Prefix:MS
Authorized Official - First Name:CHEYLA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:304-623-3461
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-0232
Mailing Address - Country:US
Mailing Address - Phone:304-265-1132
Mailing Address - Fax:304-623-7666
Practice Address - Street 1:#1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:304-623-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV932282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital