Basic Information
| Provider Information | |||||||||
| NPI: | 1396834834 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILICOTHE VAMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17273 STATE ROUTE 104 | ||||||||
| Address2: | QUARTER 13 N | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407731141 | ||||||||
| FaxNumber: | 7407727074 | ||||||||
| Practice Location | |||||||||
| Address1: | 17273 STATE ROUTE 104 | ||||||||
| Address2: | QUARTER 13 N | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407731141 | ||||||||
| FaxNumber: | 7407727074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VITURAWONG | ||||||||
| AuthorizedOfficialFirstName: | VICHIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF PULMONARY | ||||||||
| AuthorizedOfficialTelephone: | 7407731141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., FCCP. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 21635 | IA | Y | Hospitals | General Acute Care Hospital |
No ID Information.