Provider Demographics
NPI:1972529089
Name:WJB DORN VETERNS MEDICAL CENTER
Entity Type:Organization
Organization Name:WJB DORN VETERNS MEDICAL CENTER
Other - Org Name:PATHOLOGY & LAB MEDICINE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF, PATHOLOGY & LAB MEDICINE SER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:AL-ASSAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-776-4000
Mailing Address - Street 1:118 OLDE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 OLDE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6022
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:803-695-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9588282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital