Provider Demographics
NPI:1972740322
Name:VETERANS ADMINISTRATION HOSPITAL
Entity Type:Organization
Organization Name:VETERANS ADMINISTRATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GNT
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-343-1240
Mailing Address - Street 1:500 E VETERANS ST BLDG 402
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-3105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS ST BLDG 402
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:608-372-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital