Provider Demographics
NPI:1174979413
Name:C,W. BILL YOUNG VA MEDICAL CENTER
Entity type:Organization
Organization Name:C,W. BILL YOUNG VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AYLLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-398-6661
Mailing Address - Street 1:734 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4416
Mailing Address - Country:US
Mailing Address - Phone:727-793-8405
Mailing Address - Fax:
Practice Address - Street 1:521 ATWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-6810
Practice Address - Country:US
Practice Address - Phone:727-526-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5213032314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility