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	332100000X	Department of Veterans Affairs (VA) Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4532087	OTHER	TX	NCPDP#

General Provider Information

NPI Number	:	1164480018
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
Country	:	US
Telephone Number	:	615-355-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	5788 ECKHERT RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-3900
Country	:	US
Telephone Number	:	210-617-5300
Fax Number	:	210-699-2208

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	02/12/2019

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Directions to “SAN ANTONIO VAMC ” Practice Location

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