Basic Information
| Provider Information | |||||||||
| NPI: | 1679654966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA GULF COAST VETERAN HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 VETERANS AVE | ||||||||
| Address2: | |||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395312410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285235000 | ||||||||
| FaxNumber: | 2285234342 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 ON THE GRN | ||||||||
| Address2: | |||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395323229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283886480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PEDEN | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | RN/ENTEROSTOMAL THERAPY NURSE | ||||||||
| AuthorizedOfficialTelephone: | 2285235000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, CWOCN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | R598283 | MS | Y | Hospitals | General Acute Care Hospital |
No ID Information.