Provider Demographics
NPI:1144455783
Name:LOUIS STOKES VA MEDICAL CENTER
Entity type:Organization
Organization Name:LOUIS STOKES VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT AND PROGRAM ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-791-3800
Mailing Address - Street 1:2082 EAST 4TH ST APT #401
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1044
Mailing Address - Country:US
Mailing Address - Phone:614-625-9161
Mailing Address - Fax:
Practice Address - Street 1:2082 EAST 4TH ST APT #401
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1044
Practice Address - Country:US
Practice Address - Phone:614-625-9161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital