MEDICARE: SAN ANTONIO VAMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QV0200X	VA Clinic/Center

General Provider Information

NPI Number	:	1124792908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94546
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4546
Country	:	US
Telephone Number	:	615-355-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 TREELINE PARK STE 202
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2078
Country	:	US
Telephone Number	:	615-355-3451
Fax Number	:

Authorized Official
Title or Position	:	NPI TEAM LEAD
Name	:	ERIN DENISE POTTER
Credential	:
Telephone Number	:	202-382-2579

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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Directions to “SAN ANTONIO VAMC ” Practice Location

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