Basic Information
| Provider Information | |||||||||
| NPI: | 1093968166 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2979 HEATHER TRL | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337613313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277939166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10000 BAY PINES BLVD | ||||||||
| Address2: | |||||||||
| City: | BAY PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273986661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2008 | ||||||||
| LastUpdateDate: | 11/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | VAN BUSKIRK | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OF STAFF | ||||||||
| AuthorizedOfficialTelephone: | 7273986661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | ME 21505 | FL | Y | Hospitals | General Acute Care Hospital |
No ID Information.