Basic Information
| Provider Information | |||||||||
| NPI: | 1598296691 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMPHIS VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4499 GAINSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380496835 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1030 JEFFERSON AVE | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381042127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015238990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2017 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | BELMONT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM MEDICAL CENTER DIRECTOR/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9015777200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 11016 | TN | Y | Hospital Units | Rehabilitation Unit |
No ID Information.