Basic Information
| Provider Information | |||||||||
| NPI: | 1386673283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES H. QUILLEN VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | CORNER OF SIDNEY AND LAMONT | ||||||||
| Address2: | (JOHNSON CITY) | ||||||||
| City: | MOUTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | 4239793558 | ||||||||
| Practice Location | |||||||||
| Address1: | JAMES H. QUILLEN/VAMC | ||||||||
| Address2: | CORNER OF SIDNEY AND LAMONT (JOHNSON CITY) | ||||||||
| City: | MOUTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | 4239793558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | WOOD | ||||||||
| AuthorizedOfficialFirstName: | HARBER | ||||||||
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| AuthorizedOfficialTitleorPosition: | ER DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4239261171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 029967 | TN | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.