Basic Information
| Provider Information | |||||||||
| NPI: | 1962436683 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAY PINES VA HEALTH CARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 ADDISON DR NE | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337163443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275709727 | ||||||||
| FaxNumber: | 7273989549 | ||||||||
| Practice Location | |||||||||
| Address1: | 10,000 BAY PINES BLVD | ||||||||
| Address2: | |||||||||
| City: | BAY PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273986661 | ||||||||
| FaxNumber: | 7273989549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VAN BUSKIRK | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OF STAFF | ||||||||
| AuthorizedOfficialTelephone: | 7273986661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | ME 67702 | FL | Y | Hospitals | Special Hospital |
No ID Information.