NPIMap

Organization Active NPI

Jonathan M. Wainwright Memorial VA Medical Center

  • Clinical Social Worker
  • Walla Walla, WA
National Provider Identifier
1306933650
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3031 Issued in OR
Legal business name
JONATHAN M. WAINWRIGHT MEMORIAL VA MEDICAL CENTER
Practice address
77 Wainwright Dr
Building 69 Room 230 a
Walla Walla, WA
Phone
(509) 525-5200
Fax
(509) 527-3481
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Darwin Preas, MSW, LCSW
Title
Licensed Clinical Social Worker
Phone
(509) 525-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 3031 OR Primary

Addresses

Primary practice location

77 Wainwright Dr
Building 69 Room 230 a
Walla Walla, WA

Mailing address

77 Wainwright Dr
Building 69 Room 230 a
Walla Walla, WA
Phone (509) 525-5200

Other names 1

  • Walla Walla VA Medical Center Other name

National Provider Directory

National Provider Directory

Locations

77 Wainwright Dr
Bldg 69
Walla Walla, WA 99362

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306933650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 WAINWRIGHT DR",
            "address_2": "BUILDING 69 ROOM 230 A",
            "city": "WALLA WALLA",
            "state": "WA",
            "telephone_number": "509-525-5200",
            "fax_number": "509-527-3481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 WAINWRIGHT DR",
            "address_2": "BUILDING 69 ROOM 230 A",
            "city": "WALLA WALLA",
            "state": "WA",
            "telephone_number": "509-525-5200",
            "fax_number": "509-527-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONATHAN M. WAINWRIGHT MEMORIAL VA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PREAS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DARWIN",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "509-525-5200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "3031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walla Walla VA Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.