VA MEDICAL CENTER (NPI# 1760420426) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760420426 |
| Entity Type | Organization |
| Organization Name | VA MEDICAL CENTER |
| Practice Address |
1030 Jefferson Ave (117rt) Memphis TN 38104-2127 |
| Mailing Address |
1153 Greenview Rd Collierville TN 38017-6884 |
| Practice Telephone | 9015238990 |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2007-09-07 |
| Authorized Official Name | MELISSA COOK (RECREATION THERAPIST) |
| Authorized Official Telephone | 9015238990 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225800000X | Recreation Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245785179 | Va Medical Center | Military Hospital | 5939 Cedros Ave Apt A, Van Nuys, CA 91411-3104 | 2016-08-21 |
| 1104216332 | Va Medical Center | Military Hospital | 10707 W Interstate 10 Apt 436, San Antonio, TX 78230-1674 | 2015-01-26 |
| 1295178796 | Va Medical Center | Military Hospital | 16 Charles St, 3rd Floor, Lincoln, RI 02865-1906 | 2013-04-15 |
| 1487905311 | Va Medical Center | General Acute Care Hospital | 292 Sherwood Dr, Huntington, WV 25704-9460 | 2012-10-02 |
| 1033479316 | Va Medical Center | Chronic Disease Hospital | 500 Trinity Ln N Apt 5204, St Petersburg, FL 33716-1236 | 2012-05-21 |
| 1134495682 | Va Medical Center | General Acute Care Hospital | 5015 S Desoto Ct, New Berlin, WI 53151-7664 | 2012-03-29 |
| 1386952893 | Va Medical Center | General Acute Care Hospital | 6208 Krandon Drive, Raleigh, NC 27603-4928 | 2010-09-17 |
| 1093049520 | Va Medical Center | Military Hospital | 5416 Orange Valley Dr, Lakeland, FL 33813-2649 | 2009-09-30 |
| 1275784050 | Va Medical Center | Skilled Nursing Facility | 236 Pochin Pl, Hampton, VA 23661-2902 | 2008-10-10 |
| 1154587475 | Va Medical Center | General Acute Care Hospital | 4001 24th Ave W, Seattle, WA 98199-1505 | 2008-08-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | VA MEDICAL CENTER | 4101 Woolworth Ave, Omaha, NE 68105-1850 |
| System for Award Management (SAM) Entities | VA MEDICAL CENTER 581/90C | 1540 Spring Valley Dr, Huntington, WV 25704-9300 |
| Street Address |
1030 JEFFERSON AVE (117RT) |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38104-2127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982697025 | Katherine Denton Sanford | Optometrist | 1030 Jefferson Ave, Mail Code 112d, Memphis, TN 38104-2127 | 2005-08-24 |
| 1528667938 | Mckenzie Bahl | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-10-19 |
| 1427656834 | Phillip David Resuggan | Music Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2193 | 2020-10-16 |
| 1962009159 | Rachel Diann Roberts | Nurse Anesthetist, Certified Registered | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-10-01 |
| 1225643018 | Melanie Warren | Nurse Practitioner | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-09-09 |
| 1942828892 | Brady Cole | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-07-08 |
| 1457978595 | Mariko Thel | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-07-05 |
| 1215554910 | Weston Paul Keen | Pharmacy | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-06-29 |
| 1225655236 | Rebecca Fong | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-06-26 |
| 1225653660 | Brandy Hollums | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-06-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1821615873 | Altiana Carter | Optometrist | 650 New York St, Memphis, Tn 38104, Memphis, TN 38104 | 2020-06-25 |
| 1952898413 | Family To Family Adult Care Service | Chore Provider | 1331 Union Ave Suite 1028, Mempnis, TN 38104 | 2018-04-19 |
| 1326544800 | Kimberly Vestoria Mcclinton | Nurse Practitioner | 2200 Union Ave 1, Memphis, TN 38104 | 2018-04-03 |
| 1649799339 | Benjamin Duhart Jr. | Pharmacist | 1265 Union Avenue- Methodist University Hospital, Ground Floor Pharmacy Administration, Memphis, TN 38104 | 2017-09-13 |
| 1134644982 | Amy Michelle Wise | Nurse Practitioner | 1325 Eastmoreland Ave Ste 500, Memphis, TN 38104 | 2017-08-13 |
| 1316468572 | Jinger Cathey | Social Worker | 1330 Jefferson Ave, Memphis, TN 38104 | 2017-06-28 |
| 1336669183 | Charma May Kavuncu | Social Worker | 1407 Union Ave Ste 1100, Memphis, TN 38104 | 2017-06-22 |
| 1003345398 | Angelica J Dennis | Nurse Practitioner | 1265 Union, Memphis, TN 38104 | 2017-06-08 |
| 1609302546 | Cheryl Beene | Nurse Practitioner | 1211 Union Ave Ste 475, Memphis, TN 38104 | 2017-05-11 |
| Find all providers in zip 38104 | ||||
| Taxonomy Code | 225800000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Recreation Therapist |
| A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient. |
| Notes: Source: Joel A. DeLisa and Bruce M. Gans, Rehabilitation Medicine: Principles and Practice Second Edition, J.B. Lippincott Company, Philadelphia: 1993, p. 7 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1528667938 | Mckenzie Bahl | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2020-10-19 |
| 1588980585 | Gail Marie Bacher | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2010-04-15 |
| 1659558005 | Shannon Troy Hicks | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2008-01-29 |
| 1619153863 | Jason Gerald Minderman | Recreation Therapist | 1030 Jefferson Ave, Suite 117, Memphis, TN 38104-2127 | 2008-01-18 |
| 1720268758 | Walter Gramlin Dupree Jr. | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2007-11-07 |
| 1992717631 | Esther M. Wipf | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-08-12 |
| 1811925746 | Susan Buntin Matthews | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-06-29 |
| 1437190279 | John Raymond Mikula Jr. | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-06-10 |
| 1073551925 | Peggy J Neil | Recreation Therapist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-06-03 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.