Healthcare Provider Details

I. General information

NPI: 1790015402
Provider Name (Legal Business Name): MONTGOMERY VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ANDREWS AVE
FORT RUCKER AL
36362-9998
US

IV. Provider business mailing address

PO BOX 89470
CLEVELAND OH
44101-6470
US

V. Phone/Fax

Practice location:
  • Phone: 828-257-3777
  • Fax: 828-257-2399
Mailing address:
  • Phone: 828-257-2333
  • Fax: 828-257-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN POTTER
Title or Position: NPI TEAM
Credential:
Phone: 202-382-2579