Provider Demographics
NPI:1225187669
Name:JAMES H. QUILLEN VA MEDICAL CENTER
Entity type:Organization
Organization Name:JAMES H. QUILLEN VA MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-926-1171
Mailing Address - Street 1:415 S MAIN AVE
Mailing Address - Street 2:PO BOX 281
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1119
Mailing Address - Country:US
Mailing Address - Phone:423-743-9058
Mailing Address - Fax:
Practice Address - Street 1:415 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1119
Practice Address - Country:US
Practice Address - Phone:423-743-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000087275281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital