Basic Information
| Provider Information | |||||||||
| NPI: | 1578831970 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BILOXI VA HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10409 SHADY PINE DR | ||||||||
| Address2: | |||||||||
| City: | VANCLEAVE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395656527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283249321 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 VETERANS AVE | ||||||||
| Address2: | |||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395312410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285235000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2011 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | WISNIESKI | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2285235766 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | R871834 | MS | Y | Hospitals | General Acute Care Hospital |
No ID Information.