Healthcare Provider Details

I. General information

NPI: 1952264772
Provider Name (Legal Business Name): MUSKOGEE VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 S HOUSTON AVE
TULSA OK
74127-8903
US

IV. Provider business mailing address

PO BOX 94517
CLEVELAND OH
44101-4517
US

V. Phone/Fax

Practice location:
  • Phone: 913-578-4409
  • Fax:
Mailing address:
  • Phone: 913-578-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

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