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NPI Code Detail

MEDICARE: ST. LOUIS JC VAMC

MEDICARE: ST. LOUIS JC VAMC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QV0200XVA Clinic/Center

General Provider Information

NPI Number : 1114317369
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. LOUIS JC VAMC
Provider Business Mailing Address
First Line : PO BOX 94462
Second Line :
City : CLEVELAND
State : OH
Zip : 44101-4462
Country : US
Telephone Number : 913-578-4409
Fax Number :
Provider Business Practice Location Address
First Line : 515 N JEFFERSON AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-3000
Country : US
Telephone Number : 913-578-4409
Fax Number :
Authorized Official
Title or Position : NPI TEAM MEMBER
Name : ERIN D POTTER
Credential :
Telephone Number : 202-382-2579
Provider Enumeration Date : 01/27/2015
Last Update Date : 05/04/2021

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Directions to “ST. LOUIS JC VAMC ” Practice Location

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