Provider Demographics
NPI:1396834834
Name:CHILICOTHE VAMC
Entity type:Organization
Organization Name:CHILICOTHE VAMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PULMONARY
Authorized Official - Prefix:DR
Authorized Official - First Name:VICHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:VITURAWONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FCCP
Authorized Official - Phone:740-773-1141
Mailing Address - Street 1:17273 STATE ROUTE 104
Mailing Address - Street 2:QUARTER 13 N
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8608
Mailing Address - Country:US
Mailing Address - Phone:740-773-1141
Mailing Address - Fax:740-772-7074
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:QUARTER 13 N
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8608
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:740-772-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21635282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital