Healthcare Provider Details

I. General information

NPI: 1609264738
Provider Name (Legal Business Name): ORLANDO VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 S CLYDE MORRIS BLVD
PORT ORANGE FL
32129-2319
US

IV. Provider business mailing address

PO BOX 94471
CLEVELAND OH
44101-4471
US

V. Phone/Fax

Practice location:
  • Phone: 866-793-4591
  • Fax:
Mailing address:
  • Phone: 866-793-4591
  • Fax:

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