Provider Demographics
NPI: | 1780602896 |
---|---|
Name: | VETERANS AFFAIS MEDICAL CENTER |
Entity type: | Organization |
Organization Name: | VETERANS AFFAIS MEDICAL CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL PSYCHOLOGIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | STEVE |
Authorized Official - Middle Name: | HENRY |
Authorized Official - Last Name: | PENDZISZEWSKI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYD |
Authorized Official - Phone: | 269-966-5600 |
Mailing Address - Street 1: | PO BOX 117 |
Mailing Address - Street 2: | |
Mailing Address - City: | AUGUSTA |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49012-0117 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 269-668-5467 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5500 ARMSTRONG ROAD |
Practice Address - Street 2: | VAMC 515 / PSYCHOLOGY SERVICE 116B |
Practice Address - City: | BATTLE CREEK |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49015 |
Practice Address - Country: | US |
Practice Address - Phone: | 269-966-5600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-17 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 6301008704 | 283Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 283Q00000X | Hospitals | Psychiatric Hospital |