Organization Name: | PRESCOTT VAMC |
NPI Number: | 1154719458 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERIN POTTER (NPI TEAM MEMBER) |
Mailing Address: | Highway 191 And Hospital Drive Chinle |
State: | AZ US |
Postal Code: | 865039998 |
Phone Number: | 7023413307 |
Fax Number: | |
NPI Enumeration Date: | 01/08/2015 |
NPI Last Update Date: | 01/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QV0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | VA |
Taxonomy Definition: |