Healthcare Provider Details

I. General information

NPI: 1821046848
Provider Name (Legal Business Name): CHICAGO VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 MADISON ST
CROWN POINT IN
46307-7745
US

IV. Provider business mailing address

PO BOX 94474
CLEVELAND OH
44101-4474
US

V. Phone/Fax

Practice location:
  • Phone: 219-662-5093
  • Fax: 219-662-5178
Mailing address:
  • Phone: 608-821-7200
  • Fax: 608-821-7658

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