| Organization Name: | MOUNTAIN HOME VAMC |
| NPI Number: | 1285046722 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA DUNCAN (DIRECTOR, EBILLING PROJECT MANAGER) |
| Mailing Address: | 130 Independence Ln La Follette |
| State: | TN US |
| Postal Code: | 377663031 |
| Phone Number: | 6153553451 |
| Fax Number: | |
| NPI Enumeration Date: | 06/02/2014 |
| NPI Last Update Date: | 06/02/2014 |
| 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: | |