Basic Information
| Provider Information | |||||||||
| NPI: | 1518157551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MALCOM RANDALL VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 S.W 34TH STREET | ||||||||
| Address2: | APT. GG-334 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523674351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 S.W ARCHER ROAD | ||||||||
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| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
| FaxNumber: | 3523746113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | MACHADO-RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | MIRIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSE-BSN | ||||||||
| AuthorizedOfficialTelephone: | 3523761611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | RN-BSN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 024871 | PR | N | Hospitals | General Acute Care Hospital | Critical Access | 282NC0060X | 828464 | FL | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.