Basic Information
| Provider Information | |||||||||
| NPI: | 1881007136 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERAN'S AFFAIRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 EAST INDIAN SCHOOL ROAD | ||||||||
| Address2: | CARL T. HAYDEN VA MEDICAL CENTER | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 EAST INDIAN SCHOOL ROAD | ||||||||
| Address2: | CARL T. HAYDEN VA MEDICAL CENTER | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2014 | ||||||||
| LastUpdateDate: | 06/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | COMBS | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SOCIAL WORK SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 6022775551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LSCW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | Y | Hospitals | Special Hospital |
No ID Information.