Healthcare Provider Details

I. General information

NPI: 1588216618
Provider Name (Legal Business Name): RENO VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 SELMI DR
RENO NV
89512-4780
US

IV. Provider business mailing address

PO BOX 94420
CLEVELAND OH
44101-4420
US

V. Phone/Fax

Practice location:
  • Phone: 702-341-3020
  • Fax: 702-341-3503
Mailing address:
  • Phone: 702-341-3020
  • Fax: 702-341-3503

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 LEAD
Credential:
Phone: 202-382-2579