Basic Information
| Provider Information | |||||||||
| NPI: | 1801135629 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MALCOLM RANDAL VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2013 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | BENJAMIN | ||||||||
| AuthorizedOfficialFirstName: | SHERRIE | ||||||||
| AuthorizedOfficialMiddleName: | D'ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | STAFF NURSE | ||||||||
| AuthorizedOfficialTelephone: | 3522816967 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | RN9219832 | FL | Y | Hospitals | General Acute Care Hospital |
No ID Information.