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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 : 1952356115
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 : 6211 WATERFORD BLVD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-2869
Country : US
Telephone Number : 913-578-4409
Fax Number :
Authorized Official
Title or Position : NPI TEAM MEMBER
Name : ERIN POTTER
Credential :
Telephone Number : 202-382-2579
Provider Enumeration Date : 05/24/2006
Last Update Date : 01/17/2018

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Directions to “ST. LOUIS JC VAMC ” Practice Location

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