Healthcare Provider Details

I. General information

NPI: 1003874942
Provider Name (Legal Business Name): BAY PINES VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2489 DIPLOMAT PARKWAY EAST
CAPE CORAL FL
33909-5422
US

IV. Provider business mailing address

PO BOX 94465
CLEVELAND OH
44101-4465
US

V. Phone/Fax

Practice location:
  • Phone: 239-652-1800
  • Fax: 239-652-1940
Mailing address:
  • Phone: 866-793-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State

VIII. Authorized Official

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