Healthcare Provider Details

I. General information

NPI: 1790887198
Provider Name (Legal Business Name): VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN STREET VA MEDICAL CENTER
MARION IL
62959
US

IV. Provider business mailing address

11531 SUNDERLAND RD
MARION IL
62959-8274
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-4117
  • Fax:
Mailing address:
  • Phone: 618-993-4117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. LISA S MCCUTCHEN
Title or Position: DIRECTOR OF BMCL
Credential: MD
Phone: 618-993-4117