MEDICARE: MONTGOMERY 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	:	1982074720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY VAMC

Provider Business Mailing Address
First Line	:	PO BOX 89470
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-6470
Country	:	US
Telephone Number	:	828-257-2333
Fax Number	:	828-257-2399

Provider Business Practice Location Address
First Line	:	6635 BASS RD BLDG 9214
Second Line	:
City	:	FORT MOORE
State	:	GA
Zip	:	31905-5602
Country	:	US
Telephone Number	:	828-257-2333
Fax Number	:

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

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	09/09/2024

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