Basic Information
| Provider Information | |||||||||
| NPI: | 1912192402 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RALPH H. JOHNSON VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91 BOGARD ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294035230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506850537 | ||||||||
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| Practice Location | |||||||||
| Address1: | 91 BOGARD ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294035230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506850537 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2007 | ||||||||
| LastUpdateDate: | 09/08/2007 | ||||||||
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| AuthorizedOfficialLastName: | FOGG | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
| AuthorizedOfficialMiddleName: | MCDANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRIAMRY CARE SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 8506850537 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | Y | Hospitals | Military Hospital |
No ID Information.