MEDICARE: OKLAHOMA CITY 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	3723738	OTHER	OK	NCPDP

General Provider Information

NPI Number	:	1750583563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA CITY VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94537
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4537
Country	:	US
Telephone Number	:	913-578-4409
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 PITTMAN & THOMAS ROAD
Second Line	:	BLDG 4303
City	:	FORT SILL
State	:	OK
Zip	:	73503-4473
Country	:	US
Telephone Number	:	580-351-6511
Fax Number	:	580-351-6526

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	09/23/2020

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Directions to “OKLAHOMA CITY VAMC ” Practice Location

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