Malcom Randal VA Medical Center

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

MALCOM RANDAL VA MEDICAL CENTER

Practice address

1601 SW Archer Rd
Gainesville, FL 32608-1135

Phone

(352) 376-1611

NPI assigned

Jan 9, 2023

Organization subpart

No

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

Authorized official

Name

Tyra Kenyatta Lindsey

Title

Kinesiotherapist

Phone

(601) 214-7257

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1760196349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 OLD JACKSON RD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391108250",
            "telephone_number": "601-214-7257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326081135",
            "telephone_number": "352-376-1611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALCOM RANDAL VA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-05",
        "status": "A",
        "authorized_official_last_name": "LINDSEY",
        "authorized_official_first_name": "TYRA",
        "authorized_official_middle_name": "KENYATTA",
        "authorized_official_title_or_position": "KINESIOTHERAPIST",
        "authorized_official_telephone_number": "601-214-7257"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irene Andonia C Malaty, MD
• John Z Malaty, MD
• Malcolm Randal VA Medical Center
• Malcolm Randall Vamc
• Tamelia Malcolm, MS
• Malcom Randall VA Medical Center
• Malcom Randall Vamc
• Jose L Maldonado Hevia, CRNA
• Koraima Maldonado Rivera
• Erica Maldonado-Monroy

• Comprehensive Outpatient Rehabilitation Facility (CORF) in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.