Provider Demographics
NPI:1356708465
Name:VETERANS ADMISTRATION
Entity type:Organization
Organization Name:VETERANS ADMISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHSYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-221-7384
Mailing Address - Street 1:1454 JONES DAIRY ROAD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501
Mailing Address - Country:US
Mailing Address - Phone:205-221-7384
Mailing Address - Fax:
Practice Address - Street 1:1454 JONES DAIRY ROAD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501
Practice Address - Country:US
Practice Address - Phone:205-221-7384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR031181261QC1500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health