1679595763 NPI number — DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679595763 NPI number — DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679595763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10650 NW 30TH PL
Provider Second Line Business Mailing Address:
#5
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33322-1052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-748-4585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 NW 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33125-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-575-7000
Provider Business Practice Location Address Fax Number:
305-575-7079
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARTKOP
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
CAROL
Authorized Official Title or Position:
STAFF ARNP IN PRIMARY CARE
Authorized Official Telephone Number:
305-575-7000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  ARNP 58883-2 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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