Provider Demographics
NPI:1891805925
Name:WEST PALM BEACH VA MEDICAL CENTER
Entity Type:Organization
Organization Name:WEST PALM BEACH VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMAGING SERVICE CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-422-6771
Mailing Address - Street 1:6308 MYRTLEWOOD CIR W
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6740
Mailing Address - Country:US
Mailing Address - Phone:415-806-2326
Mailing Address - Fax:
Practice Address - Street 1:7305 NORTH MILITARY TRAIL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA856972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty