Healthcare Provider Details

I. General information

NPI: 1366376659
Provider Name (Legal Business Name): DANVILLE VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S MATTIS AVE STE 101
CHAMPAIGN IL
61821-5436
US

IV. Provider business mailing address

PO BOX 94478
CLEVELAND OH
44101-4478
US

V. Phone/Fax

Practice location:
  • Phone: 608-821-7200
  • Fax: 608-821-7658
Mailing address:
  • Phone: 608-821-7200
  • Fax: 608-821-7658

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