MEDICARE: FORT MEADE 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	332100000X	Department of Veterans Affairs (VA) Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4352768	OTHER	SD	NCPDP#

General Provider Information

NPI Number	:	1558319541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT MEADE VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94456
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4456
Country	:	US
Telephone Number	:	913-578-4409
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N 5TH ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-1480
Country	:	US
Telephone Number	:	605-745-2032
Fax Number	:	605-745-2839

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/26/2021

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Directions to “FORT MEADE VAMC ” Practice Location

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