MEDICARE: LAS VEGAS 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
1	261QV0200X	VA Clinic/Center

General Provider Information

NPI Number	:	1134670110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94408
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4408
Country	:	US
Telephone Number	:	702-341-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8250
Country	:	US
Telephone Number	:	702-341-3020
Fax Number	:

Authorized Official
Title or Position	:	NPI TEAM MEMBER
Name	:	ERIN POTTER
Credential	:
Telephone Number	:	202-382-2579

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/31/2017

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Directions to “LAS VEGAS VAMC ” Practice Location

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